Newborn shows liver injury after first Remdesivir dose at PGI

Tribune News Service

Naina Mishra

Chandigarh, May 20

PGI researchers have reported an odd case of a 14-day-old Covid-19 positive child showing liver injury after being injected with Remdesivir, a widely used drug in Covid-19 patients during the second wave. The research paper has alarmed against the use of Remdesivir in less severe patients.

Doctors of the Advanced Paediatrics Centre, PGI, presented the case of a newborn in paper titled “Remdesivir induced liver injury in a Covid positive newborn”, published in the Indian Journal of Paediatrics.

According to the paper, a newborn with Covid-19, who had severe hypoxemia (low oxygen level) requiring intubation, was admitted to the PGI. On administering remdesivir, the baby had worsening transaminitis (liver inflammation) requiring stoppage of the drug, following which, liver enzymes normalised over the next two weeks.

The 14-day-old baby on breastfeed developed poor feeding, lethargy and rapid breathing on Day 13 of his life. The baby had respiratory distress requiring continuous positive airway pressure (CPAP). Chest radiograph suggested viral pneumonia and the baby tested positive for Covid. The baby had worsening distress and was intubated on Day 5 of the hospital stay.

Considering the possibility of severe Covid pneumonia, the baby was injected with Remdesivir. After starting Remdesivir, the baby had significant liver inflammation after its first dose.

The researchers say drug-induced liver injury versus Covid infection-induced hepatitis was considered, and Remdesivir was stopped after the first dose.

The researchers said liver enzymes of the child gradually normalised by Day 15 of the hospital stay and the baby was discharged on Day 18 on breastfeed.

Since derangement and improvement of liver function tests had temporal association with starting and discontinuation of Remdesivir therapy, respectively, drug-induced liver injury was considered more likely, said the doctors.

“Remdesivir has shown decreased hospital duration and modest survival benefit in moderate and severe Covid infection among adult patients. Remdesivir can raise transaminases and has been avoided in patient with pre-existing liver failure. Remdesivir should be used with caution and restricted only to the cases of severe Covid infection,” read the paper.

The research paper reads

“Remdesivir has shown decreased hospital duration and modest survival benefit in moderate and severe Covid infection among adult patients. Remdesivir can raise transaminases and has been avoided in patient with pre-existing liver failure. Remdesivir should be used with caution and restricted only to cases of severe Covid infection,” read the paper.

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