ABSTRACT

Neonatal infection with SARS-CoV-2 is considered to have no major complications. A neonate with lower limb gangrene owing to spontaneous aortic thrombosis in the setting of a fetal inflammatory response syndrome (FIRS) post-intrauterine COVID-19 infection is presented. A healthy full-term newborn discharged from hospital on Day 3 developed irritability and progressive blackish discoloration of the toes of the right lower limb on Day 6 of life. Doppler imaging revealed acute thrombosis of the abdominal aorta with a critically ischaemic right lower limb. On Day 11 of life, SARS-CoV-2 RT-PCR was negative but total antibodies (IgG and IgM) were positive in both mother and neonate. The neonate showed raised inflammatory markers including CRP, ESR, interleukin-6, procalcitonin, ferritin and LDH along with elevated N-terminal pro-brain natriuretic peptide and D-dimer. In the absence of clinical signs of sepsis, FIRS was diagnosed. The neonate was treated with corticosteroids, heparin infusion and recombinant tissue plasminogen activator, and required surgical embolectomy followed by right limb amputation. By Day 31 of life, inflammatory markers showed serial return to normal and the neonate was discharged on oral steroids and aspirin. Intrauterine SARS-CoV-2 infection may trigger a systemic inflammatory response in some fetuses which is similar to post-COVID-19 multisystem inflammatory syndrome in children (MIS-C). Development of lower limb gangrene is a unique COVID-19-related neonatal complication and is attributed to thrombo-inflammation.

ABBREVIATIONS

CRP: C-reactive protein; FIRS: fetal inflammatory response syndrome; MIS-C: multisystem inflammatory syndrome in children; NT-proBNP: N-terminal pro-brain natriuretic peptide; RT-PCR: real-time polymerase chain reaction.

摘要

新生儿感染 SARS-CoV-2 被认为没有重大并发症。介绍了在胎儿炎症反应综合征 (FIRS) 宫内感染 COVID-19 后因自发性主动脉血栓形成而导致下肢坏疽的新生儿。一名健康足月新生儿于第 3 天出院，在出生第 6 天出现烦躁和右下肢脚趾渐进性变黑。多普勒成像显示右下肢严重缺血的腹主动脉急性血栓形成。在出生第 11 天，SARS-CoV-2 RT-PCR 呈阴性，但母亲和新生儿的总抗体（IgG 和 IgM）均为阳性。新生儿表现出升高的炎症标志物，包括 CRP、ESR、白细胞介素 6、降钙素原、铁蛋白和 LDH 以及升高的 N 端脑钠肽前体和 D-二聚体。在没有败血症的临床体征的情况下，诊断为 FIRS。新生儿用皮质类固醇、肝素输注和重组组织纤溶酶原激活剂治疗，并需要手术取栓，然后右肢截肢。到出生第 31 天，炎症标志物显示连续恢复正常，新生儿出院时口服类固醇和阿司匹林。宫内 SARS-CoV-2 感染可能会引发一些胎儿的全身炎症反应，这类似于儿童 C​​OVID-19 后多系统炎症综合征 (MIS-C)。下肢坏疽的发展是一种独特的 COVID-19 相关新生儿并发症，归因于血栓炎症。新生儿用皮质类固醇、肝素输注和重组组织纤溶酶原激活剂治疗，并需要手术取栓，然后右肢截肢。到出生第 31 天，炎症标志物显示连续恢复正常，新生儿出院时口服类固醇和阿司匹林。宫内 SARS-CoV-2 感染可能会引发一些胎儿的全身炎症反应，这类似于儿童 C​​OVID-19 后多系统炎症综合征 (MIS-C)。下肢坏疽的发展是一种独特的 COVID-19 相关新生儿并发症，归因于血栓炎症。新生儿用皮质类固醇、肝素输注和重组组织纤溶酶原激活剂治疗，并需要手术取栓，然后右肢截肢。到出生第 31 天，炎症标志物显示连续恢复正常，新生儿出院时口服类固醇和阿司匹林。宫内 SARS-CoV-2 感染可能会引发一些胎儿的全身炎症反应，这类似于儿童 C​​OVID-19 后多系统炎症综合征 (MIS-C)。下肢坏疽的发展是一种独特的 COVID-19 相关新生儿并发症，归因于血栓炎症。炎症标志物显示连续恢复正常，新生儿通过口服类固醇和阿司匹林出院。宫内 SARS-CoV-2 感染可能会引发一些胎儿的全身炎症反应，这类似于儿童 C​​OVID-19 后多系统炎症综合征 (MIS-C)。下肢坏疽的发展是一种独特的 COVID-19 相关新生儿并发症，归因于血栓炎症。炎症标志物显示连续恢复正常，新生儿通过口服类固醇和阿司匹林出院。宫内 SARS-CoV-2 感染可能会引发一些胎儿的全身炎症反应，这类似于儿童 C​​OVID-19 后多系统炎症综合征 (MIS-C)。下肢坏疽的发展是一种独特的 COVID-19 相关新生儿并发症，归因于血栓炎症。

缩写

CRP：C-反应蛋白；FIRS：胎儿炎症反应综合征；MIS-C：儿童多系统炎症综合征；NT-proBNP：N-末端脑钠肽前体；RT-PCR：实时聚合酶链反应。