A Case of Severe Neonatal COVID-19 Pneumonia Requiring Prolonged Mechanical Ventilation Without Long-Term Respiratory Sequelae

Numerous reports have described severe effects of novel coronavirus (SARS-CoV-2) in adults, often accompanied by long-term respiratory sequelae, such as pulmonary fibrosis. By stark contrast, most pediatric cases of respiratory illness associated with SARS-CoV-2 are mild: severe pneumonia caused by SARS-CoV-2 infection is rare in children. Nevertheless, data reflecting long-term respiratory outcomes in this population are scarce. This report describes prolonged mechanical ventilation for managing a case of severe neonatal pneumonia caused by SARS-CoV-2. The patient, a full-term neonate who developed fever at two days of age, was subsequently diagnosed with moderate acute respiratory distress syndrome (ARDS) secondary to COVID-19. Mechanical ventilation was administered for three weeks. Following extubation, the patient's respiratory condition improved steadily. He was discharged without apparent sequelae. At two-year follow-up, he had no respiratory or other systemic sequelae. To monitor for potential long-term pulmonary damage, we performed serial chest computed tomography (CT) scans and measured serum KL-6 levels. The latter were elevated during the acute phase (2,600 U/mL) but decreased to 450 U/mL within three months. CT imaging initially showed ground-glass opacities, which resolved over time. This case highlights the possibility of full recovery without long-term respiratory complications, even in neonates with severe SARS-CoV-2 pneumonia requiring prolonged ventilatory support. This report is among the very few documenting long-term follow-up in this patient population.