Presumptive Neonatal Multisystem Inflammatory Syndrome in Children Associated with Coronavirus Disease 2019

Abstract

Objective The study aimed to alert the neonatal community to the possibility of multisystem inflammatory syndrome in children (MIS-C) like disease in critically ill neonates born to mothers with coronavirus disease 2019 (COVID-19). Study Design Diagnosis of MIS-C like disease was pursued after echocardiography showed severely depressed ventricular function and pathological coronary artery dilation in the setting of medically refractory multisystem organ failure and maternal COVID-19 infection. The neonate did not respond to standard medical therapy, and there was no alternative disease that could explain the clinical course. High index of clinical suspicion coupled with low risk of intravenous immunoglobulin (IVIG) prompted us to pursue IVIG administration even though the neonate did not meet classic criteria for MIS-C. Result Following treatment with IVIG, there was rapid clinical improvement. Ventricular function improved within 15 hours and coronary artery dilation resolved in 8 days. There was no recurrence of disease during follow-up. Conclusion COVID-19 associated MIS-C like disease has not been well described in neonates. As typical features may be conspicuously absent, a high index of suspicion is warranted in critically ill neonates born to mothers with COVID-19. Echocardiography may provide critical diagnostic information and narrow the differential diagnosis. Key Points

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

“…Pregnant mother D has COVID-19 during pregnancy but the neonate remains healthy. Pregnant mother E has COVID-19 disease or exposure to SARS-COV-2 during pregnancy and the baby develops multisystem inflammation secondary to passive transfer of antibodies leading to MIS-N (multisystem inflammatory syndrome in neonates) [ 14 ].…”

“…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.…”

Multisystem inflammatory syndrome in a neonate masquerading as surgical abdomen

“…[3][4][5][6] Literature data regarding neonatal MIS-C is quite limited. [8][9][10][11][12] This entity is unique in neonates. Because infection and subsequent hyperinflammatory process could have occurred in two different individuals (infection in mother and MIS-C in neonate) or else transplacental inflammation that could have triggered this hyperinflammatory process.…”

“…To date, only four case reports involving five neonates have been described with presentations of MIS-C in the neonatal period. [8][9][10][11] Recently, Pawar et al described a case series of 20 neonates with similar features. 12 The majority of the neonates described earlier have presented with predominantly myocardial or respiratory involvement.…”

Multisystem inflammatory syndrome in neonates due to severe acute respiratory syndrome coronavirus 2: An emerging entity

“…MIS-C is less likely in neonates as their immune system is not developed. There have been a few case reports describing this condition [8][9][10]. It occurs due to cytokine storm as evidenced by the raised inflammatory markers.…”