was gradually tapered over 2 weeks then stopped; Sildenafil and Furosemide were stopped before discharge on day 34. At discharge, the baby was exclusively breast-feeding, neurologically stable, and had normal echocardiographic findings. He was well at followup after 7 days and at age 2 months; his declining antibody titers (Table 1) suggested transplacental transfer.In view of the positive anti-SARS-CoV-2 IgG antibodies in both baby and mother, transplacental transfer of maternal antibodies was considered to have potentially contributed to the hyperinflammatory response with cytokine storm seen in the neonate. A potentially MIS-C syndrome-like presentation was thought likely with multisystem involvement including lungs, skin, gut, and heart, with raised inflammatory markers (Table 1). The initial PPHN observed may have been part of the inflammatory cascade, thus accounting for the initial presentation in the absence of significant birth asphyxia, meconium aspiration, and minimal need for resuscitation at birth. DISCUSSIONThe diagnosis of MIS-C is based on 6 criteria: pediatric age, persistence of fever, presence of laboratory markers of inflammation, manifestation of signs or symptoms of organ dysfunction, lack of an alternative diagnosis, and a temporal relation to COVID-19 infection or exposure. 6 MIS-C typically presents around 3-4 weeks after acute SARS-CoV-2 infection; many affected children have positive antibodies to SARS-CoV-2, but negative PCR at the time of evaluation for MIS-C. 6 The presentation in the infant described may be a case of MIS-C in a neonate without direct evidence of SARS-CoV-2 infection but whose mother had evidence of SARS-CoV-2 infection about 3 weeks before delivery and subsequent transplacental transfer of maternal SARS-CoV-2 IgG antibodies. The pyrexial response in neonates is usually poorly developed, and the criteria suggested for diagnosing MIS-C in children may not be entirely applicable to the neonates.Transplacental transfer of specific SARS-CoV-2 IgG antibodies when measured in infants were similar to that of the mother and is thought to confer the neonate with passive immunity. [2][3][4][5] Analysis of EBM from 14 mothers following recovery from SARS-CoV-2 infection detected both IgM and IgG antibodies to SARS-CoV-2, confirming passive transfer of antibodies. 7 Although harm has not been demonstrated due to the transfer of maternal IgG antibodies to SARS-CoV-2 infection, [3][4][5]7 from anecdotal experience in older children, antibody dependent enhancement responses have been implicated in induced immune injury where low-titer neutralizing antibodies may accentuate viral triggered immune responses causing the cascade of inflammatory cytokines. [8][9][10] In our case, the transfer of maternal antibodies transplacentally and through EBM may have led to a hyperinflammatory state with cytokine storm and may have been responsible for the MIS-C like presentation. CONCLUSIONSWe believe this case to be first in the literature to report MIS-C in a neonate and highlights the imp...

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Hospital acquired infections account for high mortality rates and hospital costs. We analyzed pediatric data from a tertiary teaching hospital and found that most of cases occurred in the intensive care unit and had significant association with invasive devices. Bloodstream infections were the main site of infection and Gram-negative bacteria were the predominant etiology.

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publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. b r a z j i n f e c t d i s . 2 0 1 4;1 8(1):98-99