Multisystemic Inflammatory Syndrome in Neonates: A Systematic Review

Abstract

<b><i>Introduction:</i></b> Multisystem inflammatory syndrome in neonates (MIS-N) related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has increasingly been reported worldwide amid the spread of the SARS-CoV-2 pandemic. <b><i>Methods:</i></b> We searched PubMed, EMBASE, and CINAHL and preprint servers (BioRxiv.org and MedRxiv.org) using a specified strategy integrating Medical Subject Headings terms and keywords until October 20, 2021. Our aim was to systematically review demographic profiles, clinical features, laboratory parameters, complications, treatments, and outcomes of neonates with MIS-N. Studies were selected when fulfilling the inclusion criteria. Articles were included if they fulfilled the World Health Organization (WHO), Centers for Disease Control (CDC) definitions of MIS-C, or our proposed definition. <b><i>Results:</i></b> Sixteen reports of MIS-N including 47 neonates meeting MIS-N criteria were identified. Presentation included cardiovascular compromise (77%), respiratory involvement (55%), and fever in (36%). Eighty-three percent of patients received steroids, and 76% received immunoglobulin. Respiratory support was provided to 60% of patients and inotropes to 45% of patients. Five (11%) neonates died. <b><i>Conclusion:</i></b> The common presentation of MIS-N included cardiorespiratory compromise with the possibility of high mortality. Neonates with MIS-N related to SARS-CoV-2 may be at higher risk of adverse outcomes.

A case report: Hypoxic ischemic encephalopathy & pneumonia in a neonate after SARS-CoV-2 intrauterine transmission

“…of 20-78 mg/dl, but in our case, the CRP was only slightly elevated at 3.11 mg/dl[32][33][34][35]. Though this infant's clinical presentation in the first few days of life is likely multifactorial, we suspect the infant's respiratory decompensation at DOL 9 and 14 were due to SARS-CoV-2 related infection[36][37][38].…”

Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate

“…Severe cases may also present as multisystemic inflammatory syndrome in newborns born to mothers with SARS-CoV2 infection (MIS-N) and in newborns or children with acquired SARS-CoV2 infection (MIS-C) [163] , [164] . Multisystem inflammatory involvement manifests mainly with cardiovascular involvement, shock, myocardial dysfunction, arrhythmias and coronary dilatation.…”

Perinatal/maternal-fetal-infant dermatologic manifestations of SARS-CoV-2. An Overview and Implications for diagnosis, treatment, and prognosis

“…In 2020, a hyperinflammatory syndrome with characteristics similar to Kawasaki's Disease (KD) was reported in children with concurrent or post SARS-CoV-2 infection (73,74). The syndrome was labeled as Multisystem Inflammatory Syndrome in Children (MIS-C) or Paediatric Inflammatory Multisystem Syndrome temporarily associated with SARS-CoV-2 (PIMS-TS) and in neonates as Multisystem Inflammatory Syndrome in Neonates (MIS-N) (76)(77)(78). Although the incidence is rare, MIS-C is a potentially life threatening variant leading to severe complications including cardiac injury, multiorgan failure and death, The most commonly involved organ systems are gastrointestinal, cardiovascular, hematologic, mucocutaneous, and respiratory.…”

“…MIS-C usually occurs in children aged 9 years (ranging 1 month to 20 years) and in neonates (MIS-N) from within 7 days to 27 days post birth (77)(78)(79). The CDC criteria for MIS-C/MIS-N includes persistent fever(not MIS-N), 2 organ system involvement, laboratory evidence of inflammatory markers, laboratory evidence of current or recent SARS-CoV-2 infection or maternal infection, and no other plausible disease causing the syndrome (79,80).…”