Refractory Multi-inflammatory Syndrome in a two weeks old neonate with COVID-19 Treated Successfully with Intravenous Immunoglobulin, Steroids and Anakinra

Magboul, Samar; Khalil, Ahmed; Al-Shami, Ahmad; Alaido, Mohamed; Alhothi, Abdulla; Ellithy, Khaled; Amri, M.; Hassan, Manasik

doi:10.21203/rs.3.rs-60510/v1

Cited by 4 publications

(5 citation statements)

References 8 publications

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“…Out of the 36 infants in this cohort, four presented in critical or severe condition (Table 2). They were hospitalized for a median [range] of 70 days, of which 12.5 [3][4][5][6][7][8][9][10][11][12][13][14][15][16] days were in the intensive care unit (ICU). Two of these were considered as Both patients were managed with corticosteroids, intravenous immunoglobulin (IVIG), and human interleukin-1 receptor antagonist (anakinra), an immunomodulator agent.…”

Section: Resultsmentioning

confidence: 99%

“…MIS-C is a well-recognized disease associated with COVID-19 infection in children; however, its spectrum and sequala are not fully understood. Although the majority of reported cases are in children older than 1 month of age, a few reports described this condition in neonates (15)(16)(17). These reports indicated how challenging the diagnostic and therapeutic approaches were, and most of the patients required extensive courses of an immunomodulator agent (anakinra), IVIG, and corticosteroids (15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

“…Although the majority of reported cases are in children older than 1 month of age, a few reports described this condition in neonates (15)(16)(17). These reports indicated how challenging the diagnostic and therapeutic approaches were, and most of the patients required extensive courses of an immunomodulator agent (anakinra), IVIG, and corticosteroids (15)(16)(17). In the two cases of MIS-C presented in this study although viral myocarditis could not be excluded, given the temporality of isolation of SARS-CoV-2 in the neonate, we proposed that this can be due to SARS-CoV-2 induced effect on the myocardium in addition to the effect on other organs raising the possibility of MIS-C in the neonate.…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 Disease in Infants Less Than 90 Days: Case Series

et al. 2021

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The objective of this study is to describe the clinical presentations, radiological and laboratory findings, and outcomes of COVID-19 disease in infants ≤ 90 days of age at presentation. We conducted a retrospective study of infants in this age group who were found to be SARS-CoV-2 positive. Asymptomatic infants who were identified through routine testing following delivery to COVID-19-positive mothers were excluded. We classified infants according to their presentation: asymptomatic, mildly symptomatic, moderately symptomatic, and severely/critically symptomatic. A total of 36 infants were included. Of them, two were asymptomatic and four had severe/critical presentation. Of the severely symptomatic infants, two were considered as multisystem inflammatory syndrome in children (MIS-C) and there was one death. One infant in the severe symptomatic group presented with cardiac failure, with the possibility of congenital infection. Another infant presented with cardiogenic shock. None of these infants received antiviral medication. The study found that infants ≤ 90 days can present with a severe form of COVID-19 disease. Multisystem inflammatory syndrome in children, although rarely reported in infants, is a possible complication of COVID-19 disease and can be associated with significant morbidity and mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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COVID-19 Disease in Infants Less Than 90 Days: Case Series

et al. 2021

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“…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] …”

mentioning

confidence: 99%

“…Serologies of mothers and their neonates presenting with MIS-N and laboratory/radiological investigation[4,5,14,[16][17][18][19][20][21][22][23][24][25][26][27][28] …”

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confidence: 99%

Multisystemic Inflammatory Syndrome in Neonates: A Systematic Review

Shaiba

Hadid

et al. 2022

Neonatology

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Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.

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Neonatal Multisystem Inflammatory Syndrome Consequent to Perinatal SARS-COVID-2- Infection: A Narrative Review Study

Hantoushzadeh

Orimi

Zarkesh

et al. 2022

J Obstet Gynecol Cancer Res

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Several studies have described multisystem inflammatory syndrome (MIS) in children, but very few investigations presented this syndrome among neonates (MIS-N). The present study has reviewed the current knowledge about MIS-N, its etiology, symptoms, and outcomes to attract special attention with an eye on earlier diagnosis and treatment of newborns affected by perinatal SARS-CoV-2-infection. A narrative review study was conducted (Tehran, Iran, 2021). All types of full English articles (up to October 1 2021) were included. Detailed research on academic search engines was performed. The implemented Mesh-based keywords were "SARS-COVID-2" OR "COVID-19" OR "coronavirus" AND "Neonate" OR "Neonatal" OR "Newborn" AND "Multisystem Inflammatory Syndrome" OR "MIS-N" OR "inflammatory response syndrome" AND "Pregnancy" OR "Perinatal" OR "prenatal". Finally, 15 Full-text articles were included that met the eligibility criteria. Available data related to the disease, its etiology, presentations, and its outcome were collected and discussed. The cause of MIS-N is the transmission or production of SARS-CoV2 antibodies in response to SARS-CoV2 infection. By involving different organs, the clinical manifestations of MIS-N may mimic sepsis, toxic shock syndrome, RDS, Kawasaki disease, necrotizing enterocolitis, myocarditis, meningitis/encephalitis, aortic thrombosis, ETC. Besides the clinical presentations, detecting reactive anti-SARS-CoV-2 IgG antibodies could be a notable clue in MIS-N diagnosis. Supportive therapy, suppressing the autoimmune and inflammatory responses, anti-platelet agents, and anticoagulants were reported as the effective therapeutic agents to improve the outcome. The present study highlighted the possibility of MIS-N as an infrequent but severe syndrome consequent to perinatal COVID-19 infection. Although the diagnosis is still controversial, clinical suspicion, laboratory findings, and early treatment initiation could improve the outcome of this immunological disease.

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Refractory Multi-inflammatory Syndrome in a two weeks old neonate with COVID-19 Treated Successfully with Intravenous Immunoglobulin, Steroids and Anakinra

Cited by 4 publications

References 8 publications

COVID-19 Disease in Infants Less Than 90 Days: Case Series

COVID-19 Disease in Infants Less Than 90 Days: Case Series

Multisystemic Inflammatory Syndrome in Neonates: A Systematic Review

Neonatal Multisystem Inflammatory Syndrome Consequent to Perinatal SARS-COVID-2- Infection: A Narrative Review Study

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