Neonatal multisystem inflammatory syndrome (Mis-n) associated with prenatal maternal sars-cov-2: A case series

Ravindra Pawar, Vijay Gavade, Nivedita Patil, Vijay Mali, Amol Girwalkar, Vyankatesh Tarkasband, Sanjog Loya, Amit Chavan, Narendra Nanivadekar, Rahul Shinde, Uday Patil, Satyan Lakshminrusimha

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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.

Original languageEnglish (US)
Article number572
JournalChildren
Volume8
Issue number7
DOIs
StatePublished - Jul 2021

Keywords

  • Anti SARS-CoV-2 antibodies
  • COVID-19
  • Multisystem inflammatory syndrome in children (MIS-C)
  • Neonate

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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