Multisystem Inflammatory Syndrome In Neonates Associated With SARS-CoV2 infection- A case series.

Abstract

Multisystem inflammatory syndrome(MIS) in children (MIS-C) associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) is well recognised in children, however, rarely reported in newborns. We describe a case series of 20 neonates who were diagnosed as MIS in neonates (MIS-N). We grouped cases into three categories as Most likely MIS(5), Possible MIS(9) and Unlikely MIS(6). All neonates had high titres of SARS CoV 2 IgG antibodies and were negative for SARS CoV 2 antigens. The most common clinical findings noted in Most Likely MIS neonates were respiratory distress (4/5), shock with hypotension (4/5) and encephalopathy (4/5). Inflammatory markers like CRP (1/5), Procalcitonin (1/5), Ferritin (3/5), D-dimer (4/5) and LDH (2/5) were found to be elevated, and four of them had significantly high levels of proBNP. The majority of them (4/5) responded to immunomodulators, three discharged home and two neonates died. The most common clinical findings in Possible MIS infants were fever (6/9), respiratory distress (3/9), refusal to feeds (6/9), lethargy (5/9) and tachycardia (3/9). ProBNP as a marker of cardiac dysfunction was noted to be elevated in five infants correlating with Echocardiography in two. All infants in this group responded to immunomodulators.MIS-N manifested as a milder disease in term neonates than preterms, where it was a more severe presentation with cardiac dysfunction. The diagnosis of MIS-N can be challenging and requires a high index of suspicion and early, proactive management. However, it is also important to be cautious of incorrect or overdiagnosis of this condition during the current pandemic.

Multisystem Inflammatory Syndrome in Neonates following Maternal SARS-CoV-2 COVID-19 Infection

“…Multisystem inflammation, coronary dilation, 11 thrombosis, AV conduction block, and ↑ inflammatory markers 12 13…”

“…More et al have presented five similar cases of MIS-C-like clinical features in neonates (MIS-N). 13 Diggikar et al reported a case of early neonatal acute SARS-CoV-2 infection followed by a multisystem inflammatory response. 14 These and the other reports outlined in ►Table 1, [15][16][17][18][19][20][21] suggesting an overlap between four possible manifestations of COVID-19 during the neonatal period (►Table 2).…”

Mother to Newborn Transmission of SARS-CoV-2 Infection: Evolution of Evidence in 1.5 Years of COVID-19 Pandemic

“…98 Neonatal cases of MIS-C (Neonatal MIS-C, or MIS-N) are rarely reported, and their clinical presentation is not well-established. 99 100 101 102 103 Orlanski-Meyer et al reported a 6-week-old infant with severe gastrointestinal symptoms, anemia, elevated D-dimers, ferritin, hypoalbuminemia, and thrombocytosis then thrombocytopenia. Echocardiography in this infant showed normal coronary arteries with mitral regurgitation.…”

Partnerships in the Comprehensive Management of Multisystem Inflammatory Syndrome in Neonates (MIS-N): Translating 2 Years of Pediatric Practice to the Neonatal Wards

“…Increase in the occurrence of multisystem inflammatory syndrome in neonates (MIS-N) has been reported within the last few months, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 including a recent case report describing a newborn with acute respiratory distress syndrome intubated on day 1 of life and diagnosed with possible MIS-N on day 4, treated with intravenous immunoglobulins (IVIGs) and steroids. The newborn also developed encephalopathy and severe endotheliitis of coronary arteries.…”

“…Till January 18, 2022, more than 50 cases of MIS-N have been reported. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 As in older infants and children, the lack of a diagnostic test makes the clinical diagnosis challenging in non-specific cases. This may be specifically applicable to newborns and preterm ones as well, where there is a wide differential diagnosis of cases with acutely worsening conditions.…”