1例危重型新型冠状病毒奥密克戎变异株感染肺炎早产儿救治分析

Analysis of the treatment of a premature infant with critical coronavirus disease caused by the Omicron variant of SARS-CoV-2

患儿女性,出生胎龄30+4周,臀位助产娩出,于天津市第一中心医院新生儿科住院治疗44 d,呼吸平稳,血氧饱和度稳定,完全经口喂养,体质量规律增长,家属接患儿出院。患儿生后47 d,矫正胎龄37^(+2)周,因"纳差15 h,呼吸不规则伴反应弱4 h"入院。此次入院前1 d其母出现咽部不适,入院当日其母出现发热,体温最高37.9℃(后自行测新型冠状病毒抗原为阳性)。患儿入院前约15 h家属发现其纳奶欠佳,吸吮力减弱,入院前约4 h出现呼吸不规则,反应减弱;入院后可见频繁呼吸暂停,予调整无创辅助通气支持呼吸模式及参数、枸橼酸咖啡因兴奋呼吸中枢未见缓解,改为机械通气支持呼吸等对症支持治疗。咽拭子新型冠状病毒核酸检测N基因的Ct值为20.1,胸部X线片提示双肺野多发斑片状模糊影,确诊为奥密克戎变异株引起的危重型新型冠状病毒感染(COVID)。经治疗患儿住院8 d临床治愈出院。早产儿COVID症状可不典型,病情可在短期内急剧恶化,在奥密克戎变异株流行期间,我们应充分关注到早产儿这一群体,及早发现重症、危重症,积极治疗,改善预后。

The patient is a female infant who was born at a gestational age of 30+4 weeks in the breech position and was delivered by assisted vaginal delivery.She was admitted to the neonatal department of Tianjin First Central Hospital for 44 days,during which she had stable respiration,oxygen saturation,and regular weight gain.The patient was discharged home by her family.The infant was readmitted to the hospital due to poor appetite for 15 hours and irregular breathing with weak response for 4 hours at the corrected gestational age of 37^(+2)weeks at 47 days after birth.The day before admission,the patient's mother experienced throat discomfort,and on the day of admission,the mother had a fever,with the highest temperature of 37.9℃(she later tested positive for SARS-CoV-2 antigen).About 15 hours before admission,the family noticed that the patient had poor milk intake and weakened suction.About 4 hours before admission,the patient developed irregular breathing and weakened responses.After admission,the patient presented frequent apnea,and it was not relieved by adjusting the respiratory mode and parameters of non-invasive assisted ventilation,as well as caffeine citrate to stimulate the respiratory center.The patient was eventually given mechanical ventilation and other symptomatic support treatments.The pharyngeal swab was positive for COVID nucleic acid testing with a Ct value of 20.1 for the N gene.And the chest X-ray showed multiple patchy shadows in both lungs.The patient was diagnosed with critical coronavirus disease(COVID)caused by the Omicron variant in premature infants.After treatment,the child was clinically cured and discharged 8 days after hospitalization.Symptoms of COVID in premature infants may be atypical,and the condition can deteriorate rapidly.During the Omicron variant epidemic,we should pay more attention to premature infants so as to detect severe and critical cases as early as possible,and treat them actively to improve the prognosis.