Publication

Abstract : A 24-day-old female neonate was admitted to the paediatric cardiac intensive care unit with features of cardiogenic shock. She was born at term with a birthweight of 3·75 kg to a mother with a history of RT-PCR-positive, mild COVID-19 at 31 weeks gestation, which was managed with symptomatic and supportive measures. There were no fetal complications during the illness. The mother was RT-PCR-negative at delivery. Following an uncomplicated vaginal delivery, the neonate required supportive care for 5 days in a neonatal intensive care unit for mild tachypnoea and was subsequently discharged home with normal clinical, radiological, and laboratory parameters; RT-PCR for SARS-CoV-2 was not done. She stayed well at home until day 22 of life when she required admission to a local hospital with heart failure and systemic hypoperfusion. There was no preceding history of fever, rash, loose stools, abdominal distention, lethargy, or seizures. Following inadequate response to treatment, she was referred to our department (the Department of Pediatric Cardiology at the Amrita Institute of Medical Sciences and Research Centre, Kochi, India), with suspicion of a critical congenital heart disease. At presentation (day 0) she was afebrile, drowsy, tachycardic (heart rate: 160 beats per minute), hypotensive (mean blood pressure: 25 mm Hg), and tachypnoeic (respiratory rate: 55 breaths per minute), with chest retractions, oxygen saturation of 97% on supplemental oxygen, cool peripheries, and delayed capillary refill. The precordium was hyperdynamic, with no cardiac murmurs; the chest was clear. Hepatomegaly was present. Neither neurological or musculoskeletal abnormalities nor dysmorphisms were noted. Erythema was noted at pressure points—over the occiput and at bilateral gluteal regions; no other skin or mucosal lesions were present. The patient had metabolic acidosis with an arterial pH of 7·173 and lactate concentration of 22 mmol/L. The electrocardiogram showed sinus rhythm and the chest x-ray showed cardiomegaly, with normal lung fields. The point-of-care echocardiogram showed severe biventricular dysfunction with a left ventricular ejection fraction of 10% and global hypokinesia. Coronary arteries were normal in origin and luminal dimensions, but appeared prominent and hyperechoic. Major congenital heart disease, including outflow tract obstructions, was ruled out. Features of primary cardiomyopathies or storage disorders were absent.