Although <2% of coronavirus disease 2019 (COVID-19) infections are reported in the pediatric population, children with comorbidities such as congenital heart disease and those at a younger age are more likely to become critically ill.1-3 Remdesivir has been reported to be efficacious in adults with COVID-194; however, there are no studies in children. Convalescent plasma (CP) can contain neutralizing antibodies to viruses,5 and has been used during previous viral epidemics with clinical improvement.6-11 COVID-19 CP (C19-CP) may be useful in critically ill adults, resulting in improvement in inflammatory markers, pulmonary lesions, and mortality.12 However, the impact of C19-CP in pediatric patients, particularly infants with developing immune systems and significant comorbidities, is completely unknown.
We present an infant with cardiopulmonary failure secondary to unrepaired congenital heart disease exacerbated by COVID-19. Given postsurgical complications of children with viral respiratory infection,13-17 the patient required clearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for surgical candidacy. We hypothesized that C19-CP administration may clear SARS-CoV-2 following failure of remdesivir.