Case Report: Severe COVID-19 with Late-Onset Sepsis-like Illness in a Neonate

A case of severe COVID-19 with late-onset sepsis-like illness is presented in a neonate. A male infant was born to a mother with mild COVID-19 symptoms and positive IgG anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through spontaneous vaginal delivery. He and his mother were then confirmed to have SARS-CoV-2 infection. His condition was stable and discharge from the hospital was planned. However, on day 6 of care, his condition deteriorated, and after treatment with the COVID-19 protocol and antibiotic administration (because neonatal sepsis had not been ruled out), his condition gradually improved and he was discharged in good clinical condition without any sequelae. The pitfalls of this case are the presence of late-onset severe COVID-19, and the difficulty in monitoring patients in isolation rooms, which makes it challenging to differentiate and manage therapy between severe COVID-19 and neonatal sepsis. The similarities between the presentation of sepsis and severe COVID-19 require a thorough anamnesis, careful observation, and a thorough workup for alternative causes of sepsis to be able to make wise antibiotics treatment decisions, to prevent mismanagement, and to reduce morbidity and mortality, especially in developing countries such as Indonesia.