During the coronavirus disease 2019 (COVID-19) pandemic, few children have been infected, and those affected have had a typically milder course than adults. We describe an ex-premature infant who presented with severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection in the fifth week of life. His clinical course differs from other reported pediatric cases showing only mild respiratory system involvement. Severe respiratory distress developed in a short time frame, following severe airway compromise due to significant glottic swelling. Although his condition initially improved, severe acute respiratory distress syndrome (ARDS) developed at the time prophylactic steroids were given to prepare for extubation. High frequency oscilatory ventilation, nitric oxide, and intermittent prone positioning were then required, and after the use of the antiviral agent remdesivir, he made a full recoverybefore being discharged from the hospital.