Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 2 2022 09 26 61 64 Maryam Saeedi Department of Pediatrics, Division of Neonatology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Razieh Sangsari Department of Pediatrics, Division of Neonatology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. kayvan Mirnia Department of Pediatrics, Division of Neonatology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2021 04 23 2021 08 02 After the Ministry of the health of Iran officially announced widespread of COVID-19 on 19 February 2020, our attention focused on novel coronavirus. In our case, a2-day- old neonate shows symptoms of sepsis. The main presentation was hypothermia and desaturation. The mother was COVID-19 positive with an active cough. The PCR of the neonate was negative. We don’t claim that the neonate is affected by COVID-19, but this may be an atypical form of sepsis in neonates with positive mothers following COVID-19. A2-day- old female neonate with a gestational age of 40 weeks and a birth weight of 2370 grams was born via the cesarean route from a mother who was a 34-year-old primigravida woman without any history of disease during pregnancy. Two days before delivery, the mother had malaise and dry cough. She was diagnosed as a COVID-19 positive case based on RT-PCR after delivery. On the second day after birth, the parents brought the baby to the emergency room of the children’s medical center hospital with complaints of poor feeding, poor sucking and decreased urination. Physical examination revealed the following signs; hypothermia; T=36℃, diminished primitive reflexes, hypotonia, and oxygen desaturation until 85% without respiratory distress that increased to 98% with oxy hood. We admitted and treated her early-onset sepsis and discharged in excellent condition.Early-onset sepsis as defined is a clinical state that is transferred from mother. The presentations in our case maybe a new form of clinical sepsis following a mother with COVID-19. We don’t claim that our case is COVID-19 positive but in neonates with affected mother’s insidious symptoms should be in concern. https://crcp.tums.ac.ir/index.php/crcp/article/view/520