Multisystem inflammatory syndrome in neonates (MIS-N) associated with SARS-CoV2 infection: a case series

Abstract

Multisystem inflammatory syndrome in neonates (MIS-N) is hypothesised to be caused either following transplacental transfer of SARS-CoV2 antibodies or antibodies developed in the neonate after infection with SARS-CoV-2. In this paper, we aim to discuss the clinical manifestations, laboratory features, and management of neonates diagnosed with MIS-N. We collated information from five participating hospitals in western India. A cohort of newborn infants presenting with multi-system involvement, along with the presence of SARS-CoV2 antibodies, was identified. Current proposed international diagnostic criteria for MIS-N were used to group the cases into three categories of Most likely, Possible, and Unlikely MIS-N. A total of 20 cases were reported with a diagnosis of MIS-N, all having high titres of SARS CoV2 IgG antibodies and negative for SARS CoV2 antigens. Most likely MIS ( n = 5) cases presented with respiratory distress (4/5), hypotension and shock (4/5), and encephalopathy (2/5). 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 neonates were discharged home, and two died. Possible MIS infants ( n = 9) presented with fever (7/9), respiratory distress (4/9), refusal to feed (6/9), lethargy (5/9), and tachycardia (3/9). ProBNP as a marker of cardiac dysfunction was noted to be elevated in four (4/9) infants, correlating with abnormal echocardiography findings in two. In the Unlikely MIS ( n = 6) category, three (3/6) infants presented with respiratory distress, one (1/6) with shock and cardiac dysfunction, and only one (1/6) with fever. All of them had elevated inflammatory markers. However, there were other potential diagnoses that could have been responsible for the clinical scenarios in these six cases. Conclusion : MIS-N requires a high index of suspicion and should be considered in a neonate presenting with two or more systems involvement, in the presence of SARS-CoV2 antibodies, along with elevated inflammatory markers, once other common neonatal conditions have been ruled out. What is Known: • Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) associated multisystem inflammatory syndrome in children (MIS-C) is widely reported in paediatric population, however only few reports of newborn affection. • MIS-C is known to cause by virus-induced post-infective antibody mediated immune dysregulation with severe multi-system affection. What is New: • MIS-N may present with varied clinical manifestations with multi-system involvement of variable severity with ...

Multisystemic Inflammatory Syndrome in Neonates: A Systematic Review

“…2. Late MIS-N − hypothesized as occurring due to antibodies produced secondarily to SARS-CoV-2 infection in the newborn when the neonate presents with clinical and laboratory features beyond the first 72 h of age [ 14 ].…”

“…Demographic, clinical presentation, length of the hospital stay, and outcome of neonates with MIS-N[4,5,14,[16][17][18][19][20][21][22][23][24][25][26][27][28] …”

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

“…On January 18, 2022, more than 50 cases of MIS-N have been described (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). As in older infants and children, the lack of a diagnostic test makes the clinical diagnosis challenging in non specific cases.…”

Comparative Evaluation of Systemic Immune Indexes in Infants Born to COVID-19 PCR Positive and Negative Mothers - Can Neonatal Effects Be Predicted?

“…In this study, it was shown that some inflammatory tests of even asymptomatic infants born to mothers with infections and who did not require intensive care follow-up differed from those of healthy infants born to COVID-19 PCR negative mothers. Although there is no detailed study in the literature about the period of postnatal life until when this difference may last, in a study by More et al 27 in which 20 MIS-N cases were included, the SARS-CoV-2 IgG levels were found to be high, but the antigen levels were negative and it was shown that MIS-N condition might develop in case babies born to mothers with COVID-19 disease encountered the SARS-CoV-2 virus. In line with this information, it can be thought that inflammatory indices may be useful in the prediction of MIS-N and in the follow-up of treatment.…”