Siblings with Severe Neonatal ARDS: Immune Deficiency Versus COVID-19

Neonatal acute respiratory distress syndrome (ARDS) is a relatively new diagnosis. Specific treatment, beyond managing the underlying disease, generally relies on lung protective ventilation strategies. Viral infections such as coronavirus-2 are associated with severe ARDS. Dysfunctions in innate immunity contribute to the loss of control over viral replication and inflammatory processes, inevitably leading to a more severe clinical presentation and poor outcomes. In this case report, we present the cases of two siblings diagnosed and managed as N-ARDS with severe combined immune deficiency related to adenosine deaminase deficiency. These cases highlight the challenges of managing neonatal ARDS and the severity of viral infections in patients with immune system disorders, underlining the impact of these conditions on clinical outcomes.