Abstract：
At 23 days of life a neonate presented to the emergency room with crying and decreased oral intake. His parents were positive to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), but he turned out negative. After one week he was admitted to NICU (neonatal intensive care unit) for respiratory failure, and nasopharyngeal swab (PCR test: polymerase chain reaction test) was positive for SARS-CoV-2. On examination the child had fever, tachy-dyspnea, reduced oxygen saturation, tachycardia, abdominal distension and tenderness, irritability and hypertonia. Blood exam showed respiratory acidosis, lymphocytopenia, hypoalbuminemia and coagulopathy; CRP (C reactive protein), procalcitonin, D-dimer, ferritin and NT-proBNP (N-terminal prohormone of brain natriuretic peptide) were elevated. Chest X-ray revealed bilateral interstitial infi ltration and abdomen ultrasound a thin fl uid effusion; echocardiography was normal. SARS-CoV-2 PCR tests on CSF (cerebrospinal fluid) and stool were also positive. He was started on non-invasive intermittent positive pressure respiratory ventilation, treated with antibiotic therapy, methylprednisolone, intravenous immunoglobulins, and antiplatelet therapy. Rapid clinical improvement was seen with remission of fever after eight days. The child complicated with bacterial super-infection presenting as pleural empyema. As presented in our case, it is not always easy to differentiate between severe forms of COVID-19 and MIS-C. Due to the rarity of these presentations in neonates, multicentric collaboration is needed to identify the specifi c characteristics of the two forms, better defi ne diagnostic criteria, and treatment options.
摘要：
在生命的23天时，一名新生儿因哭泣和减少的口服摄入量而出现在急诊室。他的父母对SARS-CoV-2（严重急性呼吸道综合症冠状病毒2）呈阳性，但结果是消极的.一周后，他因呼吸衰竭入院NICU（新生儿重症监护病房），鼻咽拭子(PCR检测:聚合酶链反应检测)SARS-CoV-2阳性。经检查，孩子发烧了，心动过速-呼吸困难,氧饱和度降低,心动过速,腹胀和压痛，烦躁和高张力。血液检查显示呼吸性酸中毒,淋巴细胞减少症,低白蛋白血症和凝血病;CRP(C反应蛋白),降钙素原,D-二聚体,铁蛋白和NT-proBNP（脑钠肽的N末端激素原）升高。胸部X线检查显示双侧间质灌注，腹部超声检查显示稀薄的液体积液；超声心动图正常。SARS-CoV-2对CSF（脑脊液）和粪便的PCR检测也呈阳性。他开始接受无创间歇性正压呼吸通气，用抗生素治疗，甲基强的松龙,静脉注射免疫球蛋白，和抗血小板治疗。八天后发烧缓解，临床症状迅速改善。儿童并发细菌过度感染，表现为胸膜脓胸。如我们的案例所示，区分严重形式的COVID-19和MIS-C并不总是容易的。由于这些在新生儿中的表现很少，需要多中心合作来确定这两种形式的具体特征，更好的定义诊断标准，和治疗选择。
