Int J Clin Pediatr

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

Journal website https://www.theijcp.org

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 1	Case 2	Case 3
SARS-CoV-2 disease: severe acute respiratory syndrome coronavirus 2; ECMO: extracorporeal membrane oxygenation.
Severity of maternal SARS- CoV-2 disease	Requiring ECMO	Asymptomatic, positive test 2 months prior to delivery	Cough, vomiting
Gestational age	29 1/7 weeks	27 6/7 weeks	36 1/7 weeks
Birth weight	1,275 g (64.7th percentile)	665 g (5.1th percentile)	2,800 g (53.5th percentile)
Length	38 cm (61.6th percentile)	31 cm (1.7th percentile)	47 cm (44.3th percentile)
Head circumference	26.3 cm (64.3th percentile)	23.6 cm (10.6th percentile)	31 cm (11.8th percentile)
Apgar scores 1/5 min	1/3	4/8	8/9

Table 1. Maternal Severity of COVID Disease, Birth History and Newborn Anthropometric Data

Case 1

Case 2

Case 3

SARS-CoV-2 disease: severe acute respiratory syndrome coronavirus 2; ECMO: extracorporeal membrane oxygenation.

Severity of maternal SARS- CoV-2 disease

Requiring ECMO

Asymptomatic, positive test 2 months prior to delivery

Cough, vomiting

Gestational age

29 1/7 weeks

27 6/7 weeks

36 1/7 weeks

Birth weight

1,275 g (64.7th percentile)

665 g (5.1th percentile)

2,800 g (53.5th percentile)

Length

38 cm (61.6th percentile)

31 cm (1.7th percentile)

47 cm (44.3th percentile)

Head circumference

26.3 cm (64.3th percentile)

23.6 cm (10.6th percentile)

31 cm (11.8th percentile)

Apgar scores 1/5 min

1/3

4/8

8/9

**Table 2.** Laboratory Results
	Case 1	Case 2	Case 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.
Infectious
SARS-CoV-2 PCR	Negative	Not done	Not done
SARS-CoV-2 antibodies (IgG + IgM)	Not done	Reactive	Reactive
Blood culture	Negative	Negative	Negative
HSV PCR blood/CSF	Not done	Not done	Negative/not done
Hematologic
Blood type	B positive	A positive	B positive
Antibody screen/DAT IgG	Negative/negative	Negative/negative	Negative/negative
Hb/Hct^a (g/dL)/%	8.3/25.2	7.4/22.5	17/48.9
Nucleated RBC^b (%) (absolute × 10³/µL)	37.5 (1.74)	232.6 (20.67)	68.9 (15.89)
Platelets^a (× 10³ /µL)	51	46	196
Retic percent^c (%) (absolute)	14.3 (0.609)	7.05 (0.173)	8.96 (0.57)
Immature reticulocyte fraction (14.5-24.6%)	6	40.4	41.2
Peripheral smear	Anisocytosis 3+, spherocytes, schistocytes 1+	Anisocytosis 2+, schistocytes 2+, increased spherocytes	Anisocytosis 3+, spherocytes 1+, schystocytes 2+
Glucose-6 phosphate dehydrogenase (U/g Hb)	Not done	Not done	5.4
Coagulation
PT^c (s)	43.7	23.3	12.8
INR^c	4.4	2.0	1.0
PTT^c (s)	> 150	42	31.1
D-dimer^c (µg/mL FEU)	Gross hemolysis	2.82	Not done
Fibrinogen^a (mg/dL)	137	94	Not done
Plasma free hemoglobin^c (mg/dL)	2,280	700	120
LDH^c (U/L)	Gross hemolysis	555	1,853
Haptoglobin (mg/dL)	Not done	8	< 8
Renal
Creatinine^c (mg/dL)	1.17	0.65	0.47
UA	Blood 3+, RBC 0 - 4	Normal	Normal
Liver
Conjugated bilirubin^c (mg/dL)	Gross hemolysis	0	0.2
Total bilirubin^c (mg/dL)	Gross hemolysis	7.4	17
AST^c (U/L)	Gross hemolysis	119	65
ALT^c (U/L)	40	5	23
Ferritin^c (ng/mL)	Not done	196	92

Table 2. Laboratory Results

Case 1

Case 2

Case 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.

Infectious

SARS-CoV-2 PCR

Negative

Not done

SARS-CoV-2 antibodies (IgG + IgM)

Not done

Reactive

Blood culture

Negative

HSV PCR blood/CSF

Not done

Negative/not done

Hematologic

Blood type

B positive

A positive

B positive

Antibody screen/DAT IgG

Negative/negative

Hb/Hct^a (g/dL)/%

8.3/25.2

7.4/22.5

17/48.9

Nucleated RBC^b (%) (absolute × 10³/µL)

37.5 (1.74)

232.6 (20.67)

68.9 (15.89)

Platelets^a (× 10³ /µL)

196

Retic percent^c (%) (absolute)

14.3 (0.609)

7.05 (0.173)

8.96 (0.57)

Immature reticulocyte fraction (14.5-24.6%)

40.4

41.2

Peripheral smear

Anisocytosis 3+, spherocytes, schistocytes 1+

Anisocytosis 2+, schistocytes 2+, increased spherocytes

Anisocytosis 3+, spherocytes 1+, schystocytes 2+

Glucose-6 phosphate dehydrogenase (U/g Hb)

Not done

5.4

Coagulation

PT^c (s)

43.7

23.3

12.8

INR^c

4.4

2.0

1.0

PTT^c (s)

> 150

31.1

D-dimer^c (µg/mL FEU)

Gross hemolysis

2.82

Not done

Fibrinogen^a (mg/dL)

137

Not done

Plasma free hemoglobin^c (mg/dL)

2,280

700

120

LDH^c (U/L)

Gross hemolysis

555

1,853

Haptoglobin (mg/dL)

Not done

< 8

Renal

Creatinine^c (mg/dL)

1.17

0.65

0.47

Blood 3+, RBC 0 - 4

Normal

Liver

Conjugated bilirubin^c (mg/dL)

Gross hemolysis

0.2

Total bilirubin^c (mg/dL)

Gross hemolysis

7.4

AST^c (U/L)

Gross hemolysis

119

ALT^c (U/L)

Ferritin^c (ng/mL)

Not done

196