I have found a few case reports about NICU graduates with BPD being admitted to PICUs with Covid-19. However, I have yet to find a case report of a former ELBW infant, who is still in the NICU, acquiring SARS-CoV-2, and deteriorating as a consequence.    With regards to publishing, well, that is in part why I started this thread. It seemed like I was observing a novel effect of a novel virus, but wanted to see if others were seeing it as well. I reached out to my local University NICU's Medical Director, and they have not seen it in their NICUs. I have a couple other calls in to other large centers, but am awaiting their response(s). I plan to get IgG and IgM ELISA next week, considering whether it's worth testing mom's milk for virus and/or antibody. My local support for academic endeavors is greatly limited (county hospital), so I would welcome a collaboration if one has access to a more robust academic infrastructure.    The baby's FiO2 needs are slightly higher today (35-40%). Work of breathing is better today, but baby remains dependent on the backup rate on NIPPV (currently set at 35 bpm). I have tested this daily by decreasing the rate at bedside. Baby continues to ride the rate and quickly desaturates if rate is weaned. A rate of 25 led to SpO2 of 70%.   This, along with some increased irritability have me slightly concerned about neurologic sequelae. Thus far, his cranial ultrasounds have been clear - even for PVL. Baby is not receiving any sedation that would interfere with respiratory drive. The last blood gas was typical of a BPD baby - a mostly compensated respiratory acidosis - thus I believe the CO2 is available to drive respirations. We have discussed whether to do an LP every day for the past 5 days, but we do not feel the baby is clinically stable enough for that yet.    Echo yesterday was unchanged from about 2 weeks ago - PFO with mild PHN. Function looks good.    We are not routinely obtaining blood gases or radiographs. Prior to NIPPV, while on 5 LPM HFNC, baby had significant atelectasis, low volumes, and chronic changes. We plan for a repeat chest radiograph tomorrow to track changes, if any.    Most recent CBC has trended toward neutropenia, but the ANC was still ~2500.    We started more frequent and prolonged tummy-time today. I guess the kids call that "proning" these days  We have considered chest physiotherapy, but worry the baby will not tolerate cup percussions.    Baby remains on full feeds and oral dexamethasone, caffeine, MVI, and midazolam as needed. We lost IV access, and although it makes us nervous to not have access, we do not have a need for an IV right now. Caffeine dose is 5 mg/kg BID.    At this time, we are using the DART protocol for dexamethasone. We made this decision based on our comfort level with using this regimen. However, if the FiO2 need continues to increase, we may need to rethink the dose. By limited accounts, it seems in PICUs they are using a dose about 4x the starting DART dose.    It seems about once per year, we have cared for a former ELBW baby, that has never left the NICU, and acquires a viral respiratory pathogen and has clinical viremia. We are day 4 of severe symptomatology with this baby. We understand that some adult covid patients have a "honeymoon" period, lasting for 7-10 days, then can acutely become critically ill. By our experience with other VRPs, this is about the time we expect slow but continued improvement.    Overall, we are trying to balance the baby's ex-premie with BPD needs with the additional support for his suspected Covid. Thus we have continued to limit blood draws, maximize nutrition, minimize radiation, continue the MVI, etc.     

@HickOnACrick thanks for sharing - have you considered to publish this experience? In Sweden (Uppsala, neighbouring city to Stockholm), there was an ex-preterm infant that came back to the ER a few weeks after discharge and ended up on the vent. Being Covid+. I don't know anything from first-hand sources, but read about this spring in the national newspaper https://www.dn.se/nyheter/sverige/sa-raddades-bebisen-i-uppsala-sveriges-yngsta-covid-patient/, maybe a Google translate would make the long article there possible to read in Google-English   

@HickOnACrick thanks you so much

We also use: (weight in kg x 3) + 9 + length of cord   This gives us an approximation of UAC depth. Half of UAC length approximates UVC depth. We use an AP radiograph to confirm placement.    There is a method by which one can use the cardiorespiratory monitor to determine position of the UVC. Essentially you set the monitor to give an auditory beep with each heart beat. Advance the UVC until the frequency of beeps decreases (this implies the tip of the UVC is at the SA node), then pull the UVC back about 1/2 cm and it should be in a pretty good position. However, those I have seen use this technique still confirm with chest radiography.    I would like to gain experience in POCUS as it might limit exposure to radiation.