SARS-CoV-2 and methemoglobinemia in the neonatal period. Case report

INTRODUCCTION: Methemoglobinemia (MetaHb) is a condition where the erythrocyte is unable to release oxygen into tissues causing tissue hypoxia and metabolic acidosis with high lactate. In adult patients with SARS-CoV2 infection, some cases of coexistence of MetaHb and refractory hypoxemia have been reported; although there are no reports of this association in the neonatal stage. CLINICAL CASES: We show two cases of premature newborns with SARS-CoV-2 infection who had multisystemic deterioration and MetaHb in the second to the thrid week of life, without microbiological isolation, or temperary relationship with known MetaHb triggers, normal G6PD levels, and partial response to exchange transfusion or infusion of methylene blue. CONCLUSION: The relationship between MetaHb and SARS-CoV-2 infection is still unknown, but its pro-inflammatory activity has recently been documented, which can increase cytokine storm and worsen the evolution and prognosis of the patient with moderate to severe infection. Further studies of these associations are therefore necessary to enable timely interventions.