Background: In the context of a global COVID-19 pandemic, there have been a variety of reports about the impact of infection to the fetus and in the immediate newborn period. Many babies appear to have a mild clinical course, but there is limited data about preterm infants. Case Presentation: A 28 week male infant was delivered with signs of fetal distress, four days after maternal infection with COVID-19. At this time, the delta variant of the virus predominated. After an initial period of stability, the baby significantly deteriorated in the second week and intensive care was escalated approaching maximal therapy. Given the life-threatening severity of the clinical condition, an off-licence trial of remdesivir was started alongside dexamethasone. With this treatment, the patient made a significant improvement and recovered. Conclusion: This case shows the feasibility of using remdesivir in the very premature neonatal population and seems to have been well tolerated.

Keywords: COVID-19, SARS CoV-2, coronavirus, prematurity, remdesivir, corticosteroids.