COVID-19 in a 5-week-old baby- A BMJ case report
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The effect of COVID-19 appears to be less in the paediatric population and there are fewer cases reported in the literature in comparison to the adult population. This is a case of a previously well 5-week-old infant who presented with fever and increased sleepiness.

A 5-week-old baby presented with 1-day history of increased sleepiness in the infant and three reported choking episodes which had occurred at home. These were short-lived, occurring with milky vomits and the infant was noted to be pale; however, remained conscious throughout without any change in respiration. The infant was bottle feeding well, passing urine and had no cough, coryza, tachypnoea, diarrhoea or fever. There was no history of any travel or of any known unwell contacts.

Full septic screen investigations including blood, urine and CSF cultures and a respiratory sample, were performed. The infant was given antibiotics and admitted to the paediatric ward. A throat swab grew Candida and was PCR positive for SARS-CoV-2. The positive COVID-19 swab was reported 16 hours from the infant’s admission time.

Following completion of a septic screen, the infant was given intravenous cefotaxime as per local antibiotic guidelines for suspected sepsis in this age group. The infant was noted to appear mottled at this time so was given a 10 mL/kg fluid bolus of 0.9% sodium chloride and was subsequently given maintenance intravenous fluids.

Learning points
-- In this case, procurement of a respiratory swab as part of a standard septic screen was key in identifying the patient as COVID-19 positive. Had this not been performed as part of the septic screen and COVID-19 not identified, this would have resulted in infection control measures not being taken and the family would not have been advised 14 days of self-isolation, in turn leading to possible further spread of the virus.

-- The diagnosis of COVID-19 needs to be considered in any paediatric patient presenting with fever, regardless of patient age, travel history or unwell contact history.

-- It has been reassuring that this infant has been mildly affected only, despite testing COVID-19 positive. She has made a full recovery.

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