#NEJMClinicalReport: Late-Onset Neonatal Sepsis in a Patient
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A 3-week-old boy presented with a 2-day history of nasal congestion, tachypnea, and reduced feeding. He was born at 36 weeks of gestation to a 21-year-old woman. He had previously received a 48-hour course of antibiotics for suspected neonatal sepsis, but the workup for sepsis was negative, and he was discharged home.

Mechanical ventilation was initiated with a positive end-expiratory pressure of 7 cm of water, a fraction of inspired oxygen of 0.6, and a mean airway pressure of 22 cm of water, resulting in the partial pressure of arterial oxygen of 49 mm Hg and partial pressure of arterial carbon dioxide of 80 mm Hg. Treatment was switched to vancomycin, cefepime, and ampicillin and was discontinued after 48 hours when the cultures were negative. Hydroxychloroquine and azithromycin were initiated for presumed Covid-19.

On day 2 after admission, the hypotension resolved. A pneumothorax that developed on the right side was successfully treated by tube thoracostomy. The results of reverse-transcriptase–polymerase-chain-reaction testing to detect SARS-CoV-2 on admission were positive on day 7; he completed the 5-day course of hydroxychloroquine and azithromycin. The patient was discharged on day 9 without supplemental oxygen. Although children are less likely than adults to have severe Covid-19, this case illustrates that it can occur and can be successfully managed with standard PICU protocols.