Multisystem inflammatory syndrome in a neonate, temporally associated with prenatal exposure to SARS-CoV-2: a case report

Kappanayil, Mahesh; Balan, Suma; Alawani, Sujata S; Mohanty, Supriya; Leeladharan, Sreelakshmi P; Gangadharan, Sreja; Jayashankar, Jessin Puliparambil; Jagadeesan, Soumya; Kumar, Anil; Gupta, Atul; Kumar, Raman

doi:10.1016/s2352-4642(21)00055-9

Cited by 71 publications

(79 citation statements)

References 18 publications

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“…Out of the 36 infants in this cohort, four presented in critical or severe condition (Table 2). They were hospitalized for a median [range] of 70 days, of which 12.5 [3][4][5][6][7][8][9][10][11][12][13][14][15][16] days were in the intensive care unit (ICU). Two of these were considered as Both patients were managed with corticosteroids, intravenous immunoglobulin (IVIG), and human interleukin-1 receptor antagonist (anakinra), an immunomodulator agent.…”

Section: Resultsmentioning

confidence: 99%

“…MIS-C is a well-recognized disease associated with COVID-19 infection in children; however, its spectrum and sequala are not fully understood. Although the majority of reported cases are in children older than 1 month of age, a few reports described this condition in neonates (15)(16)(17). These reports indicated how challenging the diagnostic and therapeutic approaches were, and most of the patients required extensive courses of an immunomodulator agent (anakinra), IVIG, and corticosteroids (15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

“…Although the majority of reported cases are in children older than 1 month of age, a few reports described this condition in neonates (15)(16)(17). These reports indicated how challenging the diagnostic and therapeutic approaches were, and most of the patients required extensive courses of an immunomodulator agent (anakinra), IVIG, and corticosteroids (15)(16)(17). In the two cases of MIS-C presented in this study although viral myocarditis could not be excluded, given the temporality of isolation of SARS-CoV-2 in the neonate, we proposed that this can be due to SARS-CoV-2 induced effect on the myocardium in addition to the effect on other organs raising the possibility of MIS-C in the neonate.…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 Disease in Infants Less Than 90 Days: Case Series

et al. 2021

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The objective of this study is to describe the clinical presentations, radiological and laboratory findings, and outcomes of COVID-19 disease in infants ≤ 90 days of age at presentation. We conducted a retrospective study of infants in this age group who were found to be SARS-CoV-2 positive. Asymptomatic infants who were identified through routine testing following delivery to COVID-19-positive mothers were excluded. We classified infants according to their presentation: asymptomatic, mildly symptomatic, moderately symptomatic, and severely/critically symptomatic. A total of 36 infants were included. Of them, two were asymptomatic and four had severe/critical presentation. Of the severely symptomatic infants, two were considered as multisystem inflammatory syndrome in children (MIS-C) and there was one death. One infant in the severe symptomatic group presented with cardiac failure, with the possibility of congenital infection. Another infant presented with cardiogenic shock. None of these infants received antiviral medication. The study found that infants ≤ 90 days can present with a severe form of COVID-19 disease. Multisystem inflammatory syndrome in children, although rarely reported in infants, is a possible complication of COVID-19 disease and can be associated with significant morbidity and mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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COVID-19 Disease in Infants Less Than 90 Days: Case Series

et al. 2021

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“…Pregnant mother C is COVID-19 positive during the perinatal period and transmits the virus to her offspring during birth leading to early-onset infection in the neonate. This baby can potentially develop MIS-C 2–4 weeks later (a rare occurrence) [ 16 ]. Pregnant mother D has COVID-19 during pregnancy but the neonate remains healthy.…”

Section: Figurementioning

confidence: 99%

“…Unlike MIS-C, where SARS-CoV-2 infection and multisystem inflammation occur in the same subject, a few case reports suggest neonatal multisystem inflammation [ 13 ] occurs secondary to maternal SARS-CoV-2 infection [ 14 , 15 , 16 , 17 ]. A few weeks after the first wave of COVID-19 in Kolhapur, India, we found an increase in the number of neonates with structurally normal hearts who presented with conduction abnormalities and were born to mothers with a past history of COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Prenatal Maternal SARS-CoV-2: A Case Series

Gavade²,

et al. 2021

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Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious immune-mediated condition, seen 3–5 weeks after COVID-19. Maternal SARS-CoV-2 may potentially cause a similar hyperinflammatory syndrome in neonates due to transplacental transfer of antibodies. We reviewed the perinatal history, clinical features, and outcomes of 20 neonates with features consistent with MIS-C related to maternal SARS-CoV-2 in Kolhapur, India, from 1 September 2020 to 30 April 2021. Anti-SARS-CoV-2 IgG and IgM antibodies were tested in all neonates. Fifteen singletons and five twins born to eighteen mothers with a history of COVID-19 disease or exposure during pregnancy presented with features consistent with MIS-C during the first 5 days after birth. Nineteen were positive for anti-SARS-CoV-2 IgG and all were negative for IgM antibodies. All mothers were asymptomatic and therefore not tested by RTPCR-SARS-CoV-2 at delivery. Eighteen neonates (90%) had cardiac involvement with prolonged QTc, 2:1 AV block, cardiogenic shock, or coronary dilatation. Other findings included respiratory failure (40%), fever (10%), feeding intolerance (30%), melena (10%), and renal failure (5%). All infants had elevated inflammatory biomarkers and received steroids and IVIG. Two infants died. We speculate that maternal SARS-CoV-2 and transplacental antibodies cause multisystem inflammatory syndrome in neonates (MIS-N). Immunomodulation may be beneficial in some cases, but further studies are needed.

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Cavitary lung lesions in a neonate: Potential manifestation of COVID‐19 related multisystem inflammatory syndrome

Bakhle

Sreekumar

Baracho

et al. 2021

Pediatric Pulmonology

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Background: The hyperinflammatory state of multisystem inflammatory syndrome in children (MIS-C) predisposes to thromboembolic complications. We report a neonate with multiple cavitary lesions in lung, which we suspect could be a manifestation of multisystem inflammatory syndrome in neonate (MIS-N) following maternal COVID-19 infection during pregnancy.Case Report: Eight-day-old neonate was referred with fever and fast breathing.Mother was positive for COVID-19 in 29th week. COVID-19 reverse-transcription polymerase chain reaction was negative, however, antibodies were positive. He had increased leucocyte count, and elevated levels of C-reactive protein (CRP), procalcitonin, ferritin, lactate dehydrogenase, and D-dimer along with bilateral reticulonodular opacities on chest radiograph and multiple nodules with evidence of cavitation in both lungs on chest tomography. All cultures were negative. A possible diagnosis of MIS was made. Infant was treated with intravenous immunoglobulin (IVIG) which he responded to with resolution of symptoms. Conclusion:Neonates exposed to COVID-19 should be evaluated for thromboembolic complications and IVIG can be one of the treatment modalities.

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Multisystem inflammatory syndrome in a neonate, temporally associated with prenatal exposure to SARS-CoV-2: a case report

Cited by 71 publications

References 18 publications

COVID-19 Disease in Infants Less Than 90 Days: Case Series

COVID-19 Disease in Infants Less Than 90 Days: Case Series

Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Prenatal Maternal SARS-CoV-2: A Case Series

Cavitary lung lesions in a neonate: Potential manifestation of COVID‐19 related multisystem inflammatory syndrome

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