International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access
Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc
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Case Report

Volume 11, Number 1, March 2022, pages 27-32

Hemolysis in Neonates Born to Mothers With History of SARS-CoV-2 Infection During Pregnancy: A Case Series


Table 1. Maternal Severity of COVID Disease, Birth History and Newborn Anthropometric Data
Case 1Case 2Case 3
SARS-CoV-2 disease: severe acute respiratory syndrome coronavirus 2; ECMO: extracorporeal membrane oxygenation.
Severity of maternal SARS- CoV-2 diseaseRequiring ECMOAsymptomatic, positive test 2 months prior to deliveryCough, vomiting
Gestational age29 1/7 weeks27 6/7 weeks36 1/7 weeks
Birth weight1,275 g (64.7th percentile)665 g (5.1th percentile)2,800 g (53.5th percentile)
Length38 cm (61.6th percentile)31 cm (1.7th percentile)47 cm (44.3th percentile)
Head circumference26.3 cm (64.3th percentile)23.6 cm (10.6th percentile)31 cm (11.8th percentile)
Apgar scores 1/5 min1/34/88/9


Table 2. Laboratory Results
Case 1Case 2Case 3
aLowest level; bat the time of hemolysis; chighest level. SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; CSF: cerebrospinal fluid; PCR: polymerase chain reaction; HSV: herpes simplex virus; Ig: immunoglobulin; DAT: direct antiglobulin test; Hct: hematocrit; Hb: hemoglobin; RBC: red blood cell; PT: prothrombin time; INR: International Normalized Ratio; PTT: partial thromboplastin time; LDH: lactate dehydrogenase; UA: urine analysis; ALT: alanine transaminase; AST aspartate aminotransferase; FEU: fibrinogen equivalent unit.
  SARS-CoV-2 PCRNegativeNot doneNot done
  SARS-CoV-2 antibodies (IgG + IgM)Not doneReactiveReactive
  Blood cultureNegativeNegativeNegative
  HSV PCR blood/CSFNot doneNot doneNegative/not done
  Blood typeB positiveA positiveB positive
  Antibody screen/DAT IgGNegative/negativeNegative/negativeNegative/negative
  Hb/Hcta (g/dL)/%8.3/25.27.4/22.517/48.9
  Nucleated RBCb (%) (absolute × 103/µL)37.5 (1.74)232.6 (20.67)68.9 (15.89)
  Plateletsa (× 103 /µL)5146196
  Retic percentc (%) (absolute)14.3 (0.609)7.05 (0.173)8.96 (0.57)
  Immature reticulocyte fraction (14.5-24.6%)640.441.2
  Peripheral smearAnisocytosis 3+, spherocytes, schistocytes 1+Anisocytosis 2+, schistocytes 2+, increased spherocytesAnisocytosis 3+, spherocytes 1+, schystocytes 2+
  Glucose-6 phosphate dehydrogenase (U/g Hb)Not doneNot done5.4
  PTc (s)43.723.312.8
  PTTc (s)> 1504231.1
  D-dimerc (µg/mL FEU)Gross hemolysis2.82Not done
  Fibrinogena (mg/dL)13794Not done
  Plasma free hemoglobinc (mg/dL)2,280700120
  LDHc (U/L)Gross hemolysis5551,853
  Haptoglobin (mg/dL)Not done8< 8
  Creatininec (mg/dL)1.170.650.47
  UABlood 3+, RBC 0 - 4NormalNormal
  Conjugated bilirubinc (mg/dL)Gross hemolysis00.2
  Total bilirubinc (mg/dL)Gross hemolysis7.417
  ASTc (U/L)Gross hemolysis11965
  ALTc (U/L)40523
  Ferritinc (ng/mL)Not done19692