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Muthiah D, Chan M, Low YW, Ramasamy SN, Amin Z, Chan-Ng PPL, Low JL, Low JM. Multisystem inflammatory syndrome in neonates (MIS-N): an updated systematic review. Front Pediatr 2024; 12:1382133. [PMID: 39026941 PMCID: PMC11256206 DOI: 10.3389/fped.2024.1382133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction The aim of the study was to summarize and update clinical features and outcomes of multisystem inflammatory syndrome in neonates (MIS-N). Methods A systematic literature search was conducted of studies on MIS-N published in PubMed, MEDLINE, EMBASE, CNKI, and WHO COVID-19 databases between 1 December 2019 and 30 June 2023. Reference lists of selected articles, Google Scholar, and pre-print servers were searched for additional studies. The methodological quality of included studies was assessed. Results Of 1,572 records screened after the initial search, 35 studies involving a total of 201 neonates with MIS-N were included. One study was retrieved from a pre-print server. For those with available data, 34/47 (78.7%) mothers were infected in the third trimester. Of the 199 mothers (two with twin pregnancies), 183 (92.0%) were from India. The median age of neonates at presentation was 2.0 days (interquartile range 1.0-9.5). Over two-thirds (144/201, 71.6%) presented with respiratory distress, while 112 (55.7%) had cardiac involvement, such as ventricular dysfunctions, involvement of coronary arteries, and atrioventricular blocks. Arrhythmias and thrombosis were reported in 15/201 (7.5%) and 2/201 (3.0%) neonates, respectively. All neonates, except one, required critical care; 64/160 (40.0%) required inotropic support and 105/187 (56.1%) required respiratory support, of whom 59/105 (56.2%) were specified to require intubation. The mortality rate was 5.0% (10/201). Discussion/Conclusion MIS-N should be considered in ill neonates presenting with involvement of two or more organ systems, especially among those neonates with cardiorespiratory dysfunctions, in the presence of proven or suspected maternal COVID-19 infection during pregnancy. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278717, PROSPERO, identifier CRD42021278717.
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Affiliation(s)
| | - Ming Chan
- Department of Nursing, Changi General Hospital, Singapore, Singapore
| | - Yue Wey Low
- Ministry of Health Holdings, Singapore, Singapore
| | - Sheena Nishanti Ramasamy
- Department of Paediatrics, Khoo Teck Puat—National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Zubair Amin
- Department of Paediatrics, Khoo Teck Puat—National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
- Department of Neonatology, Khoo Teck Puat—National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Pauline Poh Lin Chan-Ng
- Department of Paediatrics, Khoo Teck Puat—National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | | | - Jia Ming Low
- Department of Paediatrics, Khoo Teck Puat—National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
- Department of Neonatology, Khoo Teck Puat—National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
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Grimes LP, Gerber JS. Neonatal and infant infection with SARS-CoV-2. Semin Perinatol 2024; 48:151922. [PMID: 38897825 DOI: 10.1016/j.semperi.2024.151922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Despite the substantial body of investigative work describing the Coronavirus Disease 2019 (COVID-19) pandemic, its impact on neonates and infants remains less well characterized. Here, we review the data on epidemiology of COVID-19 in this population. Widespread use of universal testing for SARS-CoV-2 among pregnant persons presenting for delivery complicates interpretation of the risks of perinatal exposure. While many neonates and infants with COVID-19 are well-appearing or have only mild signs of illness, factors such as preterm birth, low birth weight, and medical comorbidities increase the risk of severe infection. We highlight potential protective maternal factors, summarize treatment options and discuss vaccine development. Higher quality data are needed to better inform our understanding of COVID-19 in neonates and infants.
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Affiliation(s)
- Logan P Grimes
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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3
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Rao S, Gross RS, Mohandas S, Stein CR, Case A, Dreyer B, Pajor NM, Bunnell HT, Warburton D, Berg E, Overdevest JB, Gorelik M, Milner J, Saxena S, Jhaveri R, Wood JC, Rhee KE, Letts R, Maughan C, Guthe N, Castro-Baucom L, Stockwell MS. Postacute Sequelae of SARS-CoV-2 in Children. Pediatrics 2024; 153:e2023062570. [PMID: 38321938 PMCID: PMC10904902 DOI: 10.1542/peds.2023-062570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 02/08/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused significant medical, social, and economic impacts globally, both in the short and long term. Although most individuals recover within a few days or weeks from an acute infection, some experience longer lasting effects. Data regarding the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) in children, or long COVID, are only just emerging in the literature. These symptoms and conditions may reflect persistent symptoms from acute infection (eg, cough, headaches, fatigue, and loss of taste and smell), new symptoms like dizziness, or exacerbation of underlying conditions. Children may develop conditions de novo, including postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions and multisystem inflammatory syndrome in children. This state-of-the-art narrative review provides a summary of our current knowledge about PASC in children, including prevalence, epidemiology, risk factors, clinical characteristics, underlying mechanisms, and functional outcomes, as well as a conceptual framework for PASC based on the current National Institutes of Health definition. We highlight the pediatric components of the National Institutes of Health-funded Researching COVID to Enhance Recovery Initiative, which seeks to characterize the natural history, mechanisms, and long-term health effects of PASC in children and young adults to inform future treatment and prevention efforts. These initiatives include electronic health record cohorts, which offer rapid assessments at scale with geographical and demographic diversity, as well as longitudinal prospective observational cohorts, to estimate disease burden, illness trajectory, pathobiology, and clinical manifestations and outcomes.
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Affiliation(s)
- Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Rachel S. Gross
- Departments of Pediatrics
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Sindhu Mohandas
- Division of Infectious Diseases
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Cheryl R. Stein
- Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Abigail Case
- Department of Pediatrics and Rehabilitation Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benard Dreyer
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nathan M. Pajor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - H. Timothy Bunnell
- Biomedical Research Informatics Center, Nemours Children’s Health, Nemours Children’s Hospital, Delaware, Wilmington, Delaware
| | - David Warburton
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elizabeth Berg
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jonathan B. Overdevest
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Mark Gorelik
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Joshua Milner
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Sejal Saxena
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kyung E. Rhee
- Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, California
| | - Rebecca Letts
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Christine Maughan
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Nick Guthe
- Population Health, NYU Grossman School of Medicine, New York, New York
| | | | - Melissa S. Stockwell
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
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4
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Siramdas D, Anudeep P, Subramanian P, Chitgupikar S. Case Series of Multisystem Inflammatory Syndrome in Neonates (MIS-N) With a Link to Coagulopathy. Cureus 2023; 15:e49681. [PMID: 38161855 PMCID: PMC10756854 DOI: 10.7759/cureus.49681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Multisystem inflammatory syndrome in neonates (MIS-N) is an emerging clinical entity observed in neonates born to mothers with exposure to the SARS-CoV-2 virus before or during the antenatal period. Methods We report 18 neonates diagnosed with MIS-N from retrospectively collected data. A total of 18 neonates (13 term and five late-preterm; 10 males) admitted to the neonatal intensive care unit (NICU) of a tertiary care medical institute, between June 2021 to November 2022, were diagnosed with MIS-N. Results The median age of presentation of the 18 neonates was 1.5 days of life. All the neonates were positive for SARS-CoV-2 IgG antibodies and had elevated D-dimer levels. Respiratory system involvement was the most common (12 of 18 neonates: 66.67%). Ten out of 18 neonates (55.55%) had coagulopathy. Seven of the ten neonates with coagulopathy had central nervous system (CNS) involvement as seizures and/or intracerebral infarcts/bleeds. Cardiovascular and gastrointestinal system involvement was observed in nine (50%) and seven (38.89%) neonates, respectively. One out of 18 neonates died due to intraventricular and cerebral hemorrhage. The mortality rate was 5.55% (n=1). Ten of 18 neonates with coagulopathy required fresh frozen plasma along with repeated therapeutic doses of injection vitamin K. Eight neonates (44.44%) required human intravenous immunoglobulin (IVIG), and three neonates (16.67%) required steroids and IVIG for recovery along with supportive care. Conclusion Coagulopathy can be one of the salient features of presentation in MIS-N. In the immediate post-pandemic era, it is essential that MIS-N is considered in the differential diagnosis of neonates presenting with intracerebral bleeds/infarcts. IVIG and steroids might play an important role in the treatment of neonates with MIS-N.
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Affiliation(s)
- Deepthi Siramdas
- Pediatrics, MediCiti Institute of Medical Sciences, Hyderabad, IND
| | - Peddi Anudeep
- Pediatrics, MediCiti Institute of Medical Sciences, Hyderabad, IND
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Terciu M, Luca I, Panait E, Leibovitz E, Mitrica M, Popovici B, Ilea A, Falup-Pecurariu OG. Early Outcome of Multisystem Inflammatory Syndrome in Neonates Diagnosed following Prenatal Maternal COVID-19 Infection: A Three-Case Series. Pediatr Rep 2023; 15:591-598. [PMID: 37873800 PMCID: PMC10594475 DOI: 10.3390/pediatric15040054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The aim of this case series report is to evaluate the characteristics of multisystem inflammatory syndrome (MIS) in neonates following prenatal maternal COVID-19 infection. METHODS We present a case series of three newborns (≤28 days of age) diagnosed with MIS due to the vertical transmission of SARS-CoV2 infection and admitted from 1 January 2021 to 1 June 2023. The inclusion criteria were negative RT-PCR-SARS-CoV-2 test in infants, initial negative IgM-SARS-CoV-2 in infants followed by the emergence of positive IgG-SARS-CoV-2 antibodies in infants and maternal COVID-19 infection in the third trimester of pregnancy. Patients enrolled in this case series were admitted due to acute febrile illnesses. RESULTS All three cases occurred in patients born at a mean gestational age of 39 weeks and who were appropriate for gestational age. The mean age at admission was 18.3 days. Fibrinogen (>400 mg/dL) and ferritin (>120 mg/dL) were elevated above the upper normal limit. Elevated levels of myocardial biomarkers (D-dimers, N-terminal pro b-type natriuretic peptide troponin T and creatine phosphokinase myocardial band) were recorded, with normal heart function evaluated using echocardiography. All three patients were treated with antibiotics; one received intravenous immunoglobulin. A 4-week follow-up was completed in two patients when their myocardial biomarkers and ferritin were still elevated but lower compared with previous examinations. D-dimers levels were normalized in 2/3 patients. CONCLUSIONS Subclinical myocarditis was diagnosed as an early outcome in infants with MIS diagnosed postnatally due to the vertical transmission of SARS-CoV2 infection and may represent a new challenge for pediatricians in the pandemic era.
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Affiliation(s)
- Maria Terciu
- Children’s Clinical Hospital, 500002 Brasov, Romania; (M.T.); (M.M.)
| | - Ioana Luca
- Children’s Clinical Hospital, 500002 Brasov, Romania; (M.T.); (M.M.)
| | - Emilia Panait
- Children’s Clinical Hospital, 500002 Brasov, Romania; (M.T.); (M.M.)
| | - Eugene Leibovitz
- Faculty of Medicine, Transilvania University, 500002 Brasov, Romania
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Maria Mitrica
- Children’s Clinical Hospital, 500002 Brasov, Romania; (M.T.); (M.M.)
- Faculty of Medicine, Transilvania University, 500002 Brasov, Romania
| | - Bianca Popovici
- Children’s Clinical Hospital, 500002 Brasov, Romania; (M.T.); (M.M.)
- Faculty of Medicine, Transilvania University, 500002 Brasov, Romania
| | - Anca Ilea
- Children’s Clinical Hospital, 500002 Brasov, Romania; (M.T.); (M.M.)
- Faculty of Medicine, Transilvania University, 500002 Brasov, Romania
| | - Oana Gabriela Falup-Pecurariu
- Children’s Clinical Hospital, 500002 Brasov, Romania; (M.T.); (M.M.)
- Faculty of Medicine, Transilvania University, 500002 Brasov, Romania
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6
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Upadhyay S, Devkota S. Multisystem inflammatory syndrome in a neonate secondary to COVID-19: a case report. Ann Med Surg (Lond) 2023; 85:5191-5195. [PMID: 37811070 PMCID: PMC10553167 DOI: 10.1097/ms9.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/08/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction and importance Multisystem inflammatory syndrome in children secondary to coronavirus disease 2019 (COVID-19) (MIS-C) is very common and may present with clinical features similar to Kawasaki disease but is rarely reported in neonates (MIS-N). Any history of maternal upper respiratory tract infection should raise suspicion of MIS-N secondary to COVID-19 in critically ill neonates. Case presentation The authors present a term neonate with gradually progressive respiratory distress requiring mechanical ventilation with marked improvement after starting immunoglobulin and steroids after blood investigations revealed high IgG COVID-19 antibody titers. Clinical findings and investigation Admitted to the Neonatal Intensive Care Unit as he received bag and mask ventilation for 30 s following delivery, he was kept under oxygen via nasal prongs; but he still had nasal flaring, subcostal retraction, and tachypnea. All the blood investigations were within normal limits except for elevated C-reactive protein. Intervention and outcome With no improvement despite oxygen via nasal prongs, he was kept under bubble continuous positive airway pressure with positive end-expiratory pressure of 5 cm of H2O. With no improvement even after 24 h of noninvasive ventilation, he was kept under mechanical ventilation in assisted pressure-controlled mode with a peak inspiratory pressure of 22 cm H2O and respiratory rate of 40 breaths/minute. As the mother gave a history of on-and-off cough for almost a month, samples were sent for COVID-19 antibodies which came out to be positive with very high titers of IgG antibodies. Intravenous steroids, immunoglobulin, and subcutaneous low molecular weight heparin were started and marked improvement was noted. The peak inspiratory pressure and FiO2 were gradually tapered off, and he was extubated on the 10th day of mechanical ventilation. Conclusion Multisystem inflammatory syndrome in neonates is rare but should always be considered in neonates with multisystem involvement and a history of maternal upper respiratory tract infection after excluding all other causes.
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Affiliation(s)
| | - Sagar Devkota
- Department of Anesthesiology and Intensive Care, Kulhudhuffushi Regional Hospital, Kulhudhuffushi, Maldives
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7
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Ramaswamy VV, Abiramalatha T, Pullattayil S AK, Trevisanuto D. Multisystem inflammatory disease in neonates (MIS-N) due to maternal COVID-19. Semin Fetal Neonatal Med 2023; 28:101431. [PMID: 37061425 DOI: 10.1016/j.siny.2023.101431] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
Multisystem inflammatory disease in neonates (MIS-N) is a disease of immune dysregulation presenting in the newborn period. Thouvgh its etiopathogenesis is proposed to be similar to multisystem inflammatory disease in Children (MIS-C), the exact pathophysiology is largely unknown as of present. The definition of MIS-N is contentious. The evidence for its incidence, the clinical features, profile of raised inflammatory markers, treatment strategies and outcomes stem from case reports, case series and cohort studies with small sample sizes. Though the incidence of MIS-N in severe acute respiratory syndrome caused by the coronavirus CoVID-2 (SARS-CoV-2) infected asymptomatic neonates is low, its incidence in symptomatic neonates is relatively higher. Further, amongst the neonates who are treated as MIS-N, the mortality rate is high. The review also evaluates the various other unresolved aspects of MIS-N from limited published literature and identifies knowledge gaps which could be areas of future research.
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Affiliation(s)
| | | | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy.
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8
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Multisystem inflammatory syndrome in neonates (MIS-N): a systematic review. Eur J Pediatr 2023; 182:2283-2298. [PMID: 36877274 PMCID: PMC9986661 DOI: 10.1007/s00431-023-04906-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/16/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023]
Abstract
Recently, a new pattern of multisystem inflammatory syndrome following an infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged globally. The initial cases were described in the adult population followed by sporadic cases in the pediatric population also. By the end of 2020, similar reports were recognised in the neonatal age group. The purpose of this study was to systematically review clinical characteristics, laboratory parameters, treatment, and outcomes of neonates with multisystem inflammatory syndrome in neonates (MIS-N). A systematic review was conducted after registering with PROSPERO and electronic databases including MEDLINE, EMBASE, PubMed, SCOPUS, Google Scholar, and Web of Science were searched from January 1st 2020 till September 30th 2022. A total of 27 studies describing 104 neonates were analysed. The mean gestation age and birth weight was 35.9 ± 3.3 weeks and 2255.7 ± 783.7 g respectively. A large proportion (91.3%) of the reported cases belonged to the South-East Asian region. The median age of presentation was 2 days (range: 1-28 days) with cardiovascular system being the predominant system involved in 83.65% followed by respiratory (64.42%). Fever was noted in only 20.2%. Commonly elevated inflammatory markers were IL-6 in 86.7% and D-dimer in 81.1%. Echocardiographic evaluation suggested ventricular dysfunction in 35.8% and dilated coronary arteries in 28.3%. Evidence of SARS-CoV-2 antibodies (IgG or IgM) was seen in 95.9% neonates and evidence of maternal SARS-CoV-2 infection, either as history of COVID infection or positive antigen or antibody test, was noted in 100% of the cases. Early MIS-N was reported in 58 (55.8%) cases, late MIS-N in 28 (26.9%), and 18 cases (17.3%) did not report the timing of presentation. There was a statistically increased proportion of preterm infants (67.2%, p < 0.001), and a trend towards increased low birth weight infants, in the early MIS-N group when compared to the infants with late MIS-N. Fever (39.3%), central nervous system (50%), and gastrointestinal manifestations (57.1%) were significantly higher in the late MIS-N group (p = 0.03, 0.02, 0.01 respectively). The anti-inflammatory agents used for the treatment of MIS-N included steroids 80.8% which were given for a median of 10 (range 3-35) days and IVIg in 79.2% with a median of 2 (range 1-5) doses. The outcomes were available for 98 cases, of whom 8 (8.2%) died during treatment in hospital and 90 (91.8%) were successfully discharged home. Conclusion: MIS-N has a predilection for late preterm males with predominant cardiovascular involvement. The diagnosis is challenging in neonatal period due to overlap with neonatal morbidities and a high risk of suspicion is warranted, especially in presence of supportive maternal and neonatal clinical history. The major limitation of the review was inclusion of case reports and case series, and highlights need of global registries for MIS-N. What is Known: • A new pattern of multisystem inflammatory syndrome following SARS-CoV-2 infection has emerged in adult population with sporadic cases now being reported in neonates. What is New: • MIS-N is an emerging condition with a heterogeneous spectrum and has a predilection for late preterm male infants. Cardiovascular system is the predominant system involved followed by respiratory, however fever remains an uncommon presentation unlike other age-groups. There are two subtypes based on timing of presentation, with early MIS-N being reported more in preterm and low-birth weight infants.
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9
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Kumar C, Anjani G, Deshmukh NN, Pothala R, Bathina SP, Dodda D, Rao ES. Multisystem Inflammatory Syndrome in Neonates (MIS-N) Related to Maternal SARS-CoV-2 Exposure. Indian J Pediatr 2023; 90:98. [PMID: 36418812 PMCID: PMC9685127 DOI: 10.1007/s12098-022-04407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Chanchal Kumar
- Neonatology Unit, Department of Pediatrics, Ankura Hospital for Women and Children, Banjara Hills, Hyderabad, Telangana, India.
| | - Gummadi Anjani
- Pediatric Rheumatology & Immunology Unit, Department of Pediatrics, Ankura Hospital for Women and Children, Hyderabad, Telangana, India
| | - Namita Neelkanth Deshmukh
- Neonatology Unit, Department of Pediatrics, Ankura Hospital for Women and Children, Banjara Hills, Hyderabad, Telangana, India
| | - Rajeev Pothala
- Neonatology Unit, Department of Pediatrics, Ankura Hospital for Women and Children, Banjara Hills, Hyderabad, Telangana, India
| | - Sushma Poornima Bathina
- Neonatology Unit, Department of Pediatrics, Ankura Hospital for Women and Children, Banjara Hills, Hyderabad, Telangana, India
| | - Deepika Dodda
- Neonatology Unit, Department of Pediatrics, Ankura Hospital for Women and Children, Banjara Hills, Hyderabad, Telangana, India
| | - Eswara S Rao
- Neonatology Unit, Department of Pediatrics, Ankura Hospital for Women and Children, Banjara Hills, Hyderabad, Telangana, India
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10
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Smith RR, Driver KC, Karber BF, Luciano AA, Berg MT, Prado IV, Teper JE. A case report: Hypoxic ischemic encephalopathy & pneumonia in a neonate after SARS-CoV-2 intrauterine transmission. J Neonatal Perinatal Med 2022; 15:851-858. [PMID: 36031910 DOI: 10.3233/npm-221026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Severe acute respiratory coronavirus 2 (SARS-CoV-2) is primarily transmitted via respiratory droplet or aerosol route. However, there is mounting evidence for intrauterine transmission. We report on a late preterm infant with suspected intrauterine acquisition of SARS-CoV-2 who experienced birth depression, hypoxic ischemic encephalopathy, multisystem organ involvement, and late onset COVID-19 pneumonia [22].
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Affiliation(s)
- R R Smith
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
| | - K C Driver
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
| | - B F Karber
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
| | - A A Luciano
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
| | - M T Berg
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
| | - I V Prado
- HCA Florida Brandon Hospital, Brandon, Florida
| | - J E Teper
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
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11
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Gámez-González L, Escrcega-Jurez A, Aguilar-Soto D, Colmenero Rascón M, García Espinosa A, Yamazaki-Nakashimada M. Multisystem inflammatory syndrome in neonates associated with SARS-CoV-2 infection, a different entity? J Neonatal Perinatal Med 2022; 16:169-177. [PMID: 36314218 DOI: 10.3233/npm-220990] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Multisystemic inflammatory syndrome in children (MIS-C) is a novel disease that is associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). MIS-C usually affects children older than 5 years of age and adolescents, with a median of 8-years and an interquartile range of 3 to 11 years. A multisystemic inflammatory disease has been described in neonates and named MIS-N (multisystemic inflammatory syndrome in Neonates). We report three cases of Mexican newborns with MIS-N presenting with multiorgan compromise and a positive anti-SARS-CoV-2 IgG who developed Kawasaki disease (KD)-like cardiac features and discuss the current dilemma regarding diagnosis and treatment in these patients.
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Affiliation(s)
- L.B. Gámez-González
- Immunology Department, Hospital Infantil de Especialidades de Chihuahua, Chihuahua, Mexico, Hospital IMSS de Gineco Obstetricia No. 15, Chihuahua, Chihuahua, Mexico
| | - A.S. Escrcega-Jurez
- Neonatology Department, Hospital IMSS de Gineco Obstetricia No. 15, Chihuahua, Chihuahua, Mexico
| | - D.E. Aguilar-Soto
- Cardiology Department Hospital IMSS Morelos Chihuahua, Chihuahua, Mexico
| | | | - A.C. García Espinosa
- Oncology Department, Hospital Infantil de Especialidades de Chihuahua, Chihuahua, Mexico. Hospital IMSS de Gineco Obstetricia No. 15, Chihuahua, Chihuahua, Mexico
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12
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Costa S, Delogu AB, Bottoni A, Purcaro V, D'Andrea V, Paladini A, Muto S, Marano R, Savino G, Secinaro A, De Benedetti F, Carsetti R, Mortari EP, Spanu T, Vento G. COVID-19-Associated Multisystem Inflammatory Syndrome in a Neonate with Atypical Coronary Artery Involvement. Am J Perinatol 2022; 29:1514-1518. [PMID: 34996119 DOI: 10.1055/a-1733-4163] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The study aimed to report a novel coronavirus disease 2019 (COVID-19)-associated multisystem inflammatory syndrome in children (MIS-C) in a neonate found to have an atypical diffuse thickening in coronary artery walls whose diagnosis required a multi-imaging approach. STUDY DESIGN A neonate presented at birth with multiple organ involvement and coronary artery anomalies. A diagnosis of MIS-C associated with COVID-19 was supported by maternal severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy, and by the presence of both immunoglobulin (Ig)-G against SARS-CoV-2 and spike-specific memory B-cells response in the neonatal blood. Other plausible causes of the multiple organ involvement were excluded. RESULT At admission, a severe coronary artery dilatation was identified on echocardiography, supporting the diagnosis of the MIS-C Kawasaki-like disease; however, coronary artery internal diameters were found to be normal using cardiac computed tomography angiography. At discharge, comparing the two imaging techniques each other, the correct diagnosis resulted to be an abnormal thickening in coronary arterial walls. These findings suggest that the inflammatory process affecting the coronary arterial wall in MIS-C could result not only in typical coronary artery lesions such as dilatation of the lumen or aneurysms development but also in abnormal thickening of the coronary artery wall. CONCLUSION Our case provides an alert for pediatric cardiologists about the complexity to assess coronary artery involvement in MIS-C and raises the question that whether an abnormal vascular remodeling, with normal inner diameters, is to be considered like coronary artery dilatation for risk stratification. KEY POINTS · COVID-19 associated MIS-C can present in neonates with multiple organ involvement.. · Coronary artery assessment in neonatal MIS-C could be complex, and a multi-imaging approach could be required.. · Beside the typical coronary artery lesions, such as dilatation of the lumen or aneurysms, also abnormal thickening of the coronary artery wall can occur..
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Affiliation(s)
- Simonetta Costa
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy
| | - Angelica B Delogu
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy.,Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anthea Bottoni
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy
| | - Velia Purcaro
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy
| | - Vito D'Andrea
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy
| | - Angela Paladini
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy
| | - Sara Muto
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Marano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy.,Dipartimento di Scienze radiologiche ed ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giancarlo Savino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy
| | - Aurelio Secinaro
- Department of Imaging, Ospedale Pediatrico Bambino Gesù, Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy
| | - Fabrizio De Benedetti
- Division of Rheumatology and Laboratory of Immuno-Rheumatology, Ospedale Pediatrico Bambino Gesù, Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy
| | - Rita Carsetti
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Ospedale Pediatrico Bambino Gesù, Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy.,Microbiology and Diagnostic Immunology Unit, Ospedale Pediatrico Bambino Gesù, Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy
| | - Eva Piano Mortari
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Ospedale Pediatrico Bambino Gesù, Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy
| | - Teresa Spanu
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Vento
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy.,Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Devin J, Marano R, Mikhael M, Feaster W, Sanger T, Ehwerhemuepha L. Epidemiology of Neonatal COVID-19 in the United States. Pediatrics 2022; 150:188898. [PMID: 35996224 DOI: 10.1542/peds.2022-056297] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Data on coronavirus disease 2019 (COVID-19) infections in neonates are limited. We aimed to identify and describe the incidence, presentation, and clinical outcomes of neonatal COVID-19. METHODS Over 1 million neonatal encounters at 109 United States health systems, from March 2020 to February 2021, were extracted from the Cerner Real World Database. COVID-19 diagnosis was assessed using severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) laboratory tests and diagnosis codes. Incidence of COVID-19 per 100 000 encounters was estimated. RESULTS COVID-19 was diagnosed in 918 (0.1%) neonates (91.1 per 100 000 encounters [95% confidence interval 85.3-97.2]). Of these, 71 (7.7%) had severe infection (7 per 100 000 [95% confidence interval 5.5-8.9]). Median time to diagnosis was 14.5 days from birth (interquartile range 3.1-24.2). Common signs of infection were tachypnea and fever. Those with severe infection were more likely to receive respiratory support (50.7% vs 5.2%, P < .001). Severely ill neonates received analgesia (38%), antibiotics (33.8%), anticoagulants (32.4%), corticosteroids (26.8%), remdesivir (2.8%), and COVID-19 convalescent plasma (1.4%). A total of 93.6% neonates were discharged home after care, 1.1% were transferred to another hospital, and discharge disposition was unknown for 5.2%. One neonate (0.1%) with presentation suggestive of multisystem inflammatory syndrome in children died after 11 days of hospitalization. CONCLUSIONS Most neonates infected with SARS-CoV-2 were asymptomatic or developed mild illness without need for respiratory support. Some had severe illness requiring treatment of COVID-19 with remdesivir and COVID-19 convalescent plasma. SARS-CoV-2 infection in neonates, though rare, may result in severe disease.
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Affiliation(s)
- Joan Devin
- Children's Health of Orange County, Orange, California.,School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Rachel Marano
- Children's Health of Orange County, Orange, California
| | | | | | - Terence Sanger
- Children's Health of Orange County, Orange, California.,University of California, Irvine, California
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14
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Multisystem inflammatory syndrome in children (MIS-C) and neonates (MIS-N) associated with COVID-19: optimizing definition and management. Pediatr Res 2022; 93:1499-1508. [PMID: 36050390 PMCID: PMC9436161 DOI: 10.1038/s41390-022-02263-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/07/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
During the SARS-CoV-2-associated infection (COVID-19), pandemic initial reports suggested relative sparing of children inversely related to their age. Children and neonates have a decreased incidence of SARS-CoV-2 infection, and if infected they manifested a less severe phenotype, in part due to enhanced innate immune response. However, a multisystem inflammatory syndrome in children (MIS-C) or paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 emerged involving coronary artery aneurysms, cardiac dysfunction, and multiorgan inflammatory manifestations. MIS-C has many similarities to Kawasaki disease and other inflammatory conditions and may fit within a spectrum of inflammatory conditions based on immunological results. More recently neonates born to mothers with SARS-CoV-2 infection during pregnancy demonstrated evidence of a multisystem inflammatory syndrome with raised inflammatory markers and multiorgan, especially cardiac dysfunction that has been described as multisystem inflammatory syndrome in neonates (MIS-N). However, there is a variation in definitions and management algorithms for MIS-C and MIS-N. Further understanding of baseline immunological responses to allow stratification of patient groups and accurate diagnosis will aid prognostication, and inform optimal immunomodulatory therapies. IMPACT: Multisystem inflammatory system in children and neonates (MIS-C and MIS-N) post COVID require an internationally recognized consensus definition and international datasets to improve management and plan future clinical trials. This review incorporates the latest review of pathophysiology, clinical information, and management of MIS-C and MIS-N. Further understanding of the pathophysiology of MIS-C and MIS-N will allow future targeted therapies to prevent and limit clinical sequelae.
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15
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Kaul A, Fursule A, Shiwarkar G, Shah S. Multisystem inflammatory syndrome-neonates (MIS-N) associated with acute kidney injury: A case report. Trop Doct 2022; 52:607-609. [PMID: 35946131 DOI: 10.1177/00494755221114327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A late preterm presented with multisystem involvement (respiratory failure, shock, acute kidney injury). Initially, the baby was managed with mechanical ventilation, inotropic support, antibiotics, fluid restriction and furosemide infusion. Despite conservative management for 12 h, urine output, metabolic status and renal function did not improve; peritoneal dialysis was therefore commenced. Intravenous immunoglobulin and methylprednisolone were introduced. Respiratory failure, shock and acute kidney injury (AKI) then resolved. The baby's condition gradually improved, and he was discharged after 19 days. On follow up, he was gaining weight satisfactorily, with no sequalae. Atypical presentation of multisystem involvement in the form of AKI should not be missed since it is treatable with definitive and supportive care and has a favorable outcome.
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Affiliation(s)
- Amita Kaul
- Neonatal and Pediatric Intensive Care Services, 468688Surya Mother and Child Care Superspecialty Hospital, Pune, India
| | - Anurag Fursule
- Neonatal and Pediatric Intensive Care Services, 468688Surya Mother and Child Care Superspecialty Hospital, Pune, India
| | - Ganesh Shiwarkar
- Neonatal and Pediatric Intensive Care Services, 468688Surya Mother and Child Care Superspecialty Hospital, Pune, India
| | - Sachin Shah
- Neonatal and Pediatric Intensive Care Services, 468688Surya Mother and Child Care Superspecialty Hospital, Pune, India
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16
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Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Maternal SARS-CoV-2 Exposure. Indian J Pediatr 2022; 89:827-828. [PMID: 35471475 PMCID: PMC9038990 DOI: 10.1007/s12098-022-04167-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/11/2022] [Indexed: 12/30/2022]
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17
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Lakshminrusimha S, Hudak ML, Dimitriades VR, Higgins RD. Multisystem Inflammatory Syndrome in Neonates following Maternal SARS-CoV-2 COVID-19 Infection. Am J Perinatol 2022; 39:1166-1171. [PMID: 34710939 DOI: 10.1055/a-1682-3075] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Satyan Lakshminrusimha
- Division of Neonatology, Department of Pediatrics, University of California Davis Children's Hospital, Sacramento, California
| | - Mark L Hudak
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - Victoria R Dimitriades
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of California Davis Children's Hospital, Sacramento, California
| | - Rosemary D Higgins
- Department of Global and Community Health, College of Health and Human Sciences, George Mason University, Fairfax, Virginia
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18
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Arun S, Cherian TG, Philip C. Multisystem inflammatory syndrome in a neonate with severe hemophilia - a diagnostic challenge in COVID times: a case report. BMC Pediatr 2022; 22:397. [PMID: 35799157 PMCID: PMC9261231 DOI: 10.1186/s12887-022-03463-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multisystem Inflammatory Syndrome in Neonates (MIS-N) can occur following antenatal COVID- 19 infection in the mother. Here we report a rare case of a neonate with Hemophilia A and MIS-N. CASE PRESENTATION A 2-day-old baby presented with an intramuscular hematoma, neonatal seizures, and isolated activated partial thromboplastin time (APTT) prolongation. The neurosonogram showed a subdural hematoma. A diagnosis of Hemophilia A was made and was confirmed by factor 8 assay and genetic analysis. Supportive measures and Factor 8 replacement was initiated. A rising trend of inflammatory markers and an ongoing need for mechanical ventilation were noted. As there was a history of COVID-19 in the mother in the third trimester, MIS-N was diagnosed. The baby was treated with intravenous immunoglobulin (IVIG) and steroids, and there was an improvement in the clinical and laboratory markers. However, the baby developed seizures on day 16. There was an increase in the subdural hemorrhage and a further rise in inflammatory markers. A craniostomy and hematoma evacuation was done and the baby improved. CONCLUSION The concurrent occurrence of hemophilia A with intracranial bleed, and MIS-N in a neonate is a diagnostic challenge. It is important to have a high index of suspicion to ensure timely diagnosis and treatment of MIS-N in this pandemic era.
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Affiliation(s)
- Sumitha Arun
- Department of Neonatology, Believers Church Medical College Hospital, Thiruvalla, Kerala, 689103, India.
| | - Taliya Grace Cherian
- Department of Neonatology, Believers Church Medical College Hospital, Thiruvalla, Kerala, 689103, India
| | - Chepsy Philip
- Department of Hematology, Believers Church Medical College Hospital, Thiruvalla, Kerala, 689103, India
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19
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Kulkarni RK, Valvi C, Dawre R, Rajput U, Nagpal R, Deshmukh I, Kamath P, Harwani R, Srinivasarangan R, Sonteke S, R A, Kamble S, Naik S, Bhosale R, Waghmare R, Modi D, Gajbhiye R, Kinikar AA. Clinical Profile of SARS-CoV-2-Infected Neonates. Cureus 2022; 14:e26298. [PMID: 35898362 PMCID: PMC9308998 DOI: 10.7759/cureus.26298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background There are conflicting data on the mother-to-child transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and few studies have described the clinical course of neonates infected with SARS-CoV-2. Objectives This study investigates the mother-to-child transmission rate and clinical profile of SARS-CoV-2-infected newborns. Methods Data on 304 newborns of 301 mothers with coronavirus disease 2019 (COVID-19) were prospectively collected and analyzed. Reverse transcription-polymerase chain reaction (RT-PCR) determined the presence of SARS-CoV-2 in the placenta, umbilical cord stump, and nasopharyngeal swabs collected within 24h of birth. Clinical and laboratory data of SARS-CoV-2-infected newborns was entered in a structured proforma. Results A total of 20 neonates (6.5%) were positive for SARS-CoV-2, of which 12 were positive only in the nasopharyngeal swab, four cases had the umbilical stump positive, three were positive in the placenta, and one case was positive in all the three specimens collected. Six of the 20 SARS-CoV-2-positive neonates developed severe symptoms. The SARS-CoV-2-positive symptomatic neonates required a more extended stay in hospital compared to their non-symptomatic infected counterparts. Conclusions A proportion of the babies born to SARS-CoV2-infected mothers tested positive and some of these newborns had severe symptoms.
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20
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Buonsenso D. Partnerships in the Comprehensive Management of Multisystem Inflammatory Syndrome in Neonates (MIS-N): Translating 2 Years of Pediatric Practice to the Neonatal Wards. Am J Perinatol 2022. [PMID: 35240695 DOI: 10.1055/a-1787-8099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Center for Global Health Research Studies, Università Cattolica del Sacro Cuore, Roma, Italia.,Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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21
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Multisystem Inflammatory Syndrome in Neonates Born to Mothers with SARS-CoV-2 Infection (MIS-N) and in Neonates and Infants Younger Than 6 Months with Acquired COVID-19 (MIS-C): A Systematic Review. Viruses 2022; 14:v14040750. [PMID: 35458480 PMCID: PMC9024762 DOI: 10.3390/v14040750] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 12/25/2022] Open
Abstract
(1) Introduction: There is an increasing literature describing neonates born to mothers with SARS-CoV-2 infection (MIS-N) and infants infected with SARS-CoV-2 who presented with a severe disease (MIS-C). (2) Methods: To investigate clinical features of multisystem inflammatory syndrome in neonates and infants under six months of age, we used a systematic search to retrieve all relevant publications in the field. We screened in PubMed, EMBASE and Scopus for data published until 10 October 2021. (3) Results: Forty-eight articles were considered, including 29 case reports, six case series and 13 cohort studies. Regarding clinical features, only 18.2% of MIS-N neonates presented with fever; differently from older children with MIS-C, in which gastrointestinal symptoms were the most common manifestation, we displayed that cardiovascular dysfunction and respiratory distress are the prevalent findings both in neonates with MIS-N and in neonates/infants with MIS-C. (4) Conclusions: We suggest that all infants with suspected inflammatory disease should undergo echocardiography, due to the possibility of myocardial dysfunction and damage to the coronary arteries observed both in neonates with MIS-N and in neonates/infants with MIS-C. Moreover, we also summarize how they were treated and provide a therapeutic algorithm to suggest best management of these fragile infants.
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22
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Shaiba LA, More K, Hadid A, Almaghrabi R, Al Marri M, Alnamnakani M, Shah P. Multisystemic Inflammatory Syndrome in Neonates: A Systematic Review. Neonatology 2022; 119:405-417. [PMID: 35512651 PMCID: PMC9148888 DOI: 10.1159/000524202] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/11/2022] [Indexed: 12/18/2022]
Abstract
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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Affiliation(s)
- Lana A Shaiba
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Neonatology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Kiran More
- Neonatal Consultant, SIDRA Medicine, Ar-Rayyan, Qatar
| | - Adnan Hadid
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Neonatology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Rana Almaghrabi
- Pediatric Infectious Disease, Pediatric Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Munira Al Marri
- Pediatric Rheumatology, Pediatric Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mahdi Alnamnakani
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Neonatology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Prakesh Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Toronto University, Toronto, Ontario, Canada.,Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
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23
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Multisystem inflammatory syndrome in neonates (MIS-N) associated with SARS-CoV2 infection: a case series. Eur J Pediatr 2022; 181:1883-1898. [PMID: 35031848 PMCID: PMC8759431 DOI: 10.1007/s00431-022-04377-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 02/06/2023]
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 milder disease in term and severe disease with cardiac dysfunction in preterm newborns. • Multisystem inflammatory syndrome in newborns (MIS-N) is postulated to occur following immune dysregulation associated with transplacental transfer of SARS-CoV2 antibodies or antibodies developed in the neonate after infection with SARS-CoV-2.
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24
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Agrawal G, Wazir S, Arora A, Sethi SK. Multisystem inflammatory syndrome in a neonate masquerading as surgical abdomen. BMJ Case Rep 2021; 14:14/10/e246579. [PMID: 34711628 PMCID: PMC8557287 DOI: 10.1136/bcr-2021-246579] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Worldwide, thousands of cases of multisystem inflammatory syndrome in children (MIS-C) have already been reported in children. Evidence regarding neonatal MIS-C is limited. We present the first case report of a neonate presenting within 48 hours of life with predominant abdominal signs mimicking surgical abdomen. Clinical picture comprised fever, multiorgan dysfunction (gastrointestinal, cardiorespiratory, hepatic and dermatological), positive inflammatory markers, high ferritin and high D-dimer levels. Cardiac enzyme N-terminal-pro-B-type natriuretic peptide as well as D-dimer levels were elevated. Blood, urine, stool and cerebrospinal fluid cultures were sterile. Positive anti-SARS-CoV-2 IgG in both the mother and the infant, along with an epidemiological evidence of maternal contact with COVID-19, clinched the diagnosis of MIS-C. Immunomodulatory drugs (intravenous immunoglobulin and systemic steroids) were administered and showed good clinical response. A high index of suspicion of MIS-C in critically ill neonates can improve outcomes.
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Affiliation(s)
- Gopal Agrawal
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Gurgaon, Haryana, India
| | - Sanjay Wazir
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Gurgaon, Haryana, India
| | - Ajay Arora
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Gurgaon, Haryana, India
| | - Sidharth Kumar Sethi
- Department of Pediatrics and Neonatology, Cloudnine Hospital, Gurgaon, Haryana, India .,Department of Pediatric Nephrology, Medanta The Medicity, Gurgaon, Haryana, India
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Pawar R, Gavade V, Patil N, Mali V, Girwalkar A, Tarkasband V, Loya S, Chavan A, Nanivadekar N, Shinde R, Patil U, Lakshminrusimha S. Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Prenatal Maternal SARS-CoV-2: A Case Series. CHILDREN (BASEL, SWITZERLAND) 2021; 8:572. [PMID: 34356552 PMCID: PMC8305422 DOI: 10.3390/children8070572] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious immune-mediated condition, seen 3-5 weeks after COVID-19. Maternal SARS-CoV-2 may potentially cause a similar hyperinflammatory syndrome in neonates due to transplacental transfer of antibodies. We reviewed the perinatal history, clinical features, and outcomes of 20 neonates with features consistent with MIS-C related to maternal SARS-CoV-2 in Kolhapur, India, from 1 September 2020 to 30 April 2021. Anti-SARS-CoV-2 IgG and IgM antibodies were tested in all neonates. Fifteen singletons and five twins born to eighteen mothers with a history of COVID-19 disease or exposure during pregnancy presented with features consistent with MIS-C during the first 5 days after birth. Nineteen were positive for anti-SARS-CoV-2 IgG and all were negative for IgM antibodies. All mothers were asymptomatic and therefore not tested by RTPCR-SARS-CoV-2 at delivery. Eighteen neonates (90%) had cardiac involvement with prolonged QTc, 2:1 AV block, cardiogenic shock, or coronary dilatation. Other findings included respiratory failure (40%), fever (10%), feeding intolerance (30%), melena (10%), and renal failure (5%). All infants had elevated inflammatory biomarkers and received steroids and IVIG. Two infants died. We speculate that maternal SARS-CoV-2 and transplacental antibodies cause multisystem inflammatory syndrome in neonates (MIS-N). Immunomodulation may be beneficial in some cases, but further studies are needed.
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Affiliation(s)
- Ravindra Pawar
- Department of Pediatrics, Dr. D Y Patil Medical College Hospital and Research Institute, Kolhapur 416003, MH, India; (N.P.); (V.M.)
| | - Vijay Gavade
- Masai Children’s Hospital, Kolhapur 416002, MH, India; (V.G.); (S.L.); (A.C.); (U.P.)
| | - Nivedita Patil
- Department of Pediatrics, Dr. D Y Patil Medical College Hospital and Research Institute, Kolhapur 416003, MH, India; (N.P.); (V.M.)
| | - Vijay Mali
- Department of Pediatrics, Dr. D Y Patil Medical College Hospital and Research Institute, Kolhapur 416003, MH, India; (N.P.); (V.M.)
- NICE Advanced Neonatal Care Centre and Children’s Clinic, Kolhapur 416008, MH, India
| | - Amol Girwalkar
- Ratna NICU, Kolhapur 416003, MH, India;
- Department of Pediatrics, Apple Saraswati Multispeciality Hospital, Kolhapur 416003, MH, India;
| | - Vyankatesh Tarkasband
- Department of Pediatrics, Apple Saraswati Multispeciality Hospital, Kolhapur 416003, MH, India;
| | - Sanjog Loya
- Masai Children’s Hospital, Kolhapur 416002, MH, India; (V.G.); (S.L.); (A.C.); (U.P.)
| | - Amit Chavan
- Masai Children’s Hospital, Kolhapur 416002, MH, India; (V.G.); (S.L.); (A.C.); (U.P.)
| | | | - Rahul Shinde
- Samarth Nursing Home, Kolhapur 416002, MH, India;
| | - Uday Patil
- Masai Children’s Hospital, Kolhapur 416002, MH, India; (V.G.); (S.L.); (A.C.); (U.P.)
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