Arterial Thrombosis and Gangrene In A Neonate With COVID-19 - A Case Report.

COVID-19 in neonates is an emerging challenge to pediatricians. Majority of the neonates with COVID-19 described so far are suspected to be due to postnatal transmission. Vertical transmission has been reported in 2 case cohort studies till date.32 weeks preemie born to primigravida mother with history of Preterm premature rupture of membranes (PPROM) was admitted in NICU with birth weight of 2 kg in view of respiratory distress. Neonate developed arterial thrombosis on first day of life and subsequent gangrene of right foot and tested positive for serology and rtPCR of SARS-CoV-2 with elevated inflammatory markers (CRP, D Dimer, Serum Ferritin, Lactate dehydrogenase). The mother was asymptomatic and hence was not tested for SARS-CoV-2 antenatally. After the confirmation in neonate, mother was also tested for SARS-CoV-2 and she tested positive by rtPCR as well as serology.This rare presentation calls for further research in transmission patterns either antenatally or vertical transmission. This report emphasizes the possibility of vertical transmission of COVID-19 in neonates from asymptomatic mother, with significant, early onset neonatal infection in the form of thrombosis.