Doctors were puzzled when Pooja’s (name changed) second throat swab tested negative. She was pregnant with twins. And during admission, she was already hypoxic with severe pneumonia. A chest CT scan showed 60% lung involvement.
Her doctors at Jehangir hospital wanted to administer remdesivir, but the negative test was holding them back. However, all changed when the husband finally disclosed she had had contact with her Covid-positive mother and grandmother.
Pooja went on to deliver the twins on September 28, becoming Jehangir’s first case of extremely premature delivery by a Covid-infected mother. Incidentally, despite severe Covid symptoms, the children too tested negative.
Doctors said the case has presented key learnings. “Severe Covid infection means the virus has reached the lower respiratory tract. So a swab from the nose and throat — parts of the upper respiratory tract — is likely to miss SARS-CoV-2 presence,” said Jehangir’s senior gynaecologist Vandana Khanijo.
Pooja delivered a boy and a girl through a caesarean section at 28 weeks. Khanijo said the decision to quickly go ahead with the caesarean was made because Pooja also needed invasive ventilation.
The twins were born weighing 1.13 kg and 940 grams. Both were quickly put on ventilator support and administered surfactant, a drug to mature their lungs.
But the girl was hit hard. She had Acute Respiratory Distress Syndrome, acute renal failure, high inflammatory markers, a heart anomaly and pulmonary edema. She also showed signs of Covid-induced organ dysfunction with evidence of the cytokine storm (an abnormal immune response seen in Covid patients), despite testing negative. “But she was off ventilator within five days and is now on minimum oxygen. She will be able to breathe on her own in a couple of days,” said Jehangir’s neonatologist and pediatric intensivist Sagar Lad.
The boy, meanwhile, needed a ventilator for three days. He was finally discharged on November 6
Doctors said the twins had won against huge odds.
“We have had babies born as early as 25 weeks. But this case was challenging as there was Covid involved,” said
neonatologist Anshu Sethi.
