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Clinical manifestations among children are generally less severe than those seen in adults, but critical cases have increasingly been reported in infants less than 1 year of age. We report a severe case of neonatal COVID\u201019 requiring intensive care and mechanical ventilation, further complicated by a multidrug\u2010resistant <jats:italic>Enterobacter asburiae<\/jats:italic> super\u2010infection. Chest X\u2010rays, lung ultrasound, and chest computed tomography revealed extensive interstitial pneumonia with multiple consolidations, associated with persistent increased work of breathing and feeding difficulties. SARS\u2010CoV\u20102 RNA was detected in respiratory specimens and stools, but not in other biological samples, with a rapid clearance in stools. Serological tests demonstrated a specific SARS\u2010CoV\u20102 antibody response mounted by the neonate and sustained over time. The therapeutic approach included the use of enoxaparin and steroids which may have contributed to the bacterial complication, underlying the challenges in managing neonatal COVID\u201019, where the balance between viral replication and immunomodulation maybe even more challenging than in older ages.<\/jats:p>","DOI":"10.1002\/jmv.27472","type":"journal-article","created":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T11:17:39Z","timestamp":1637666259000},"page":"1701-1706","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Severe neonatal COVID\u201019: Challenges in management and therapeutic approach"],"prefix":"10.1002","volume":"94","author":[{"given":"Concetta","family":"Marsico","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna Bologna Italy"},{"name":"Neonatal Intensive Care Unit IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0124-0829","authenticated-orcid":false,"given":"Maria Grazia","family":"Capretti","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arianna","family":"Aceti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna Bologna Italy"},{"name":"Neonatal Intensive Care Unit IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina","family":"Vocale","sequence":"additional","affiliation":[{"name":"Unit of Clinical Microbiology, Regional Reference Center for Microbiological Emergencies (CRREM) IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filomena","family":"Carfagnini","sequence":"additional","affiliation":[{"name":"Radiology Unit \u2013 Pediatric Division IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Serra","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Interventional, Diagnostic and Therapeutic Ultrasound Unit IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina","family":"Campoli","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna, Italy Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiziana","family":"Lazzarotto","sequence":"additional","affiliation":[{"name":"Department of Specialized, Experimental and Diagnostic Medicine, Microbiology Unit IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna, University of Bologna Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Corvaglia","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna Bologna Italy"},{"name":"Neonatal Intensive Care Unit IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,11,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.15270"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-0702"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2020.0878"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-1550"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-1121"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000002864"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piaa084"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-1701"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2010614"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000003081"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.25255"},{"key":"e_1_2_8_13_1","unstructured":"Centers for Diseases Control and Prevention. 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