Neetu Beniwal1, Payal Chaudhary2, Rameshwar Lal Suman2. 1. Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, 302004, India. neetu.beni@gmail.com. 2. Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, 302004, India.
The SARS-CoV-2 is responsible for severe viral pneumonia. WHO declared COVID-19 a pandemic on 11th March 2020 [1]. The pandemic is undermining nutrition across the world, particularly in low- and middle-income countries [2].The worst consequences of this crisis is borne by children.A 6-mo-old female infant presented with fever, diarrhea, difficulty in breathing since 5 d and was admitted in the pediatric isolation ward of a tertiary level hospital of Udaipur, Rajasthan (India). On GPE baby was febrile, had tachycardia, tachypnea with chest retraction and nasal flaring. SpO2 was 94% on room air. Baby had pallor, hyperpigmented knuckles, and thin and hypopigmented hair. Weight-for-length was < 3 SD of the median. Systemic examination revealed bilateral crepitations on auscultation. Nasopharyngeal swab of the infant for RT-PCR was positive.On laboratory testing there was dimorphic anemia (Hb-8.7 g/dL), TLC was 4200/ dL, platelet count was normal, serum CRP was raised (88.29), D-dimer was high (8299 ng/mL), serum ferritin was also raised (1650 ng/mL). HRCT revealed multiple patchy area of consolidation.Treatment started immediately according to protocol of the Ministry of Health and Family Welfare of India with O2 inhalation, IV antibiotics, IV methylprednisolone, inj. enoxaparin. Feeding initiated via NG tube. Baby improved and O2 support was weaned off after 5 d and baby was discharged after nutritional rehabilitation.Severe acute malnutrition predisposes children to various infections due to decrease in immune response. Malnutrition affects both the innate and adaptive immune responses [3]. Some micronutrients have important role in innate immune response. Although COVID-19 has been largely causing asymptomatic illness in children but presence of comorbidities is a risk factor for severe illness. Previous case report on a malnourished child with severe COVID-19 reported death of the child [4]. Early diagnosis and treatment will result in better management of patients and fewer mortality.