Neonatal dengue as never before - A case series

Abstract

Dengue is a Flavivirus, affecting about 100 million people annually and mainly in the tropical and subtropical countries. Neonatal dengue is uncommon and usually by vertical transmission or, in the postnatal period, by horizontal transmission. We describe the clinical profile, management and outcome of neonates with dengue infection. Ten patients were prospectively recruited from August to November 2019 during dengue epidemic season at Niloufer Hospital, Hyderabad, India. Four babies had vertical mode of transmission while 6 had horizontal mode of transmission. All babies were positive for Ns1 antigen and IgM dengue serology, confirming dengue infection. Fever, flushing and thrombocytopenia were observed in all the babies while 2 babies had hypotension requiring inotropes. Oxygen supplementation was required in 8 babies. There was no recorded mortality. We conclude that neonatal dengue should be considered as a differential diagnosis in a neonate with sepsis and thrombocytopenia especially in endemic regions. Judicious use of fluids (avoid excessive) and inotropes (dopamine) form the cornerstone of dengue management in neonates.

Dengue fever presenting as acute febrile illness in neonates: a case series from Pakistan

“…In India and Vietnam, the mean age of neonates with vertical transmission of dengue is reportedly 11.25 days and 7 days, respectively. 1,9 Fever was the most common symptom and flushing the most common sign in all five neonates, which echoes findings in the literature. 11 Mottling, which indicates vasomotor instability, was present in two neonates on arrival and two during their hospital stays.…”

“…Dengue antigen testing was considered due to availability of the test. Rapid early decline in platelet count (more than 2x10 9 within the first 24 hours) during the acute febrile phase was noted in four out of five cases. Leukopenia was not observed, and haematocrit levels remained within normal ranges in all five infants, including the cases of dengue haemorrhagic shock.…”

“…Similar findings have been reported in India, with ages ranging from 24 to 26 days. 9,10 Only one infant (case 3) exhibited vertical transmission of the virus, with symptoms starting around the sixth day of life. In India and Vietnam, the mean age of neonates with vertical transmission of dengue is reportedly 11.25 days and 7 days, respectively.…”

“…All patients were diagnosed in the dengue epidemic season in Pakistan. 9 WHO defines dengue haemorrhagic fever as the presence of fever, thrombocytopenia, haemorrhagic tendency with evidence of plasma leakage, and haemoconcentration ≥20% above average for age, sex, and population, and signs include plasma leakage such as pleural effusion, ascites, and hypoproteinaemia. Dengue shock syndrome is characterised by evidence of circulatory failure.…”

“…Hypoalbuminaemia of 3 gm/dl was reported. Her posttransfusion platelet count dropped again from 85×10 9 /L to 16×10 9 /L within the next 24 hours and was managed with repeat platelet transfusion. On the fourth day, her condition improved and the fever resolved (Figure 2).…”