Investigating Neonatal Multisystem Inflammatory Syndrome Associated with COVID-19 in the Neonatal Intensive Care Unit: A Case Series
Main Article Content
Abstract
Background: The COVID-19 pandemic, caused by the novel SARS-CoV-2 virus, has presented significant challenges to global healthcare systems, affecting individuals of all ages, including neonates. Recent studies have identified a condition similar to Multisystem Inflammatory Syndrome in Children (MIS-C) occurring in neonates, termed MIS-N (Multisystem Inflammatory Syndrome in Neonates), linked to maternal infection with SARS-CoV-2. Understanding MIS-N's clinical manifestations, laboratory findings, and treatment outcomes is crucial for improving neonatal care during the ongoing pandemic.
Objective: The objective of this study was to explore the clinical characteristics, laboratory diagnostics, and treatment outcomes of neonates diagnosed with MIS-N, aiming to contribute to better diagnostic and management approaches for this vulnerable population.
Methods: This retrospective case series analyzed neonates admitted with suspected MIS-N to the Children's Medical Center in Tehran, Iran, from March to September 2020. Inclusion criteria encompassed neonates showing clinical signs suggestive of MIS-N, elevated inflammatory markers, and positive for SARS-CoV-2 antibodies. Key data points included demographic information, clinical presentation, laboratory results (including complete blood count, inflammatory markers, and specific COVID-19 serology), treatment modalities, and patient outcomes. The effectiveness of interventions was evaluated based on symptom resolution and normalization of lab values.
Results: Two neonates were identified with MIS-N. Case I involved a 39-week-old male presenting with diarrhea, dehydration, fever, and a rash, with initial inflammatory markers showing a white blood count (WBC) of 23,000 cells/μL, C-reactive protein (CRP) of 93 mg/L, and serum IgG of 10 g/L. Following treatment with corticosteroids, the patient's condition stabilized, with a decrease in WBC to 18,000 cells/μL and CRP to 34 mg/L. Case II, a 38-week-old female, exhibited a cough, rashes, with WBC of 17,000 cells/μL, CRP of 2 mg/L, and serum IgG of 40 g/L. A single dose of hydrocortisone led to symptom resolution. Both cases had no significant adverse outcomes at a three-month follow-up.
Conclusion: Our findings illuminate the clinical and laboratory characteristics of MIS-N in neonates, emphasizing the role of maternal SARS-CoV-2 infection in its etiology. The successful resolution of symptoms with corticosteroid treatment highlights the potential efficacy of this intervention in managing MIS-N. These insights contribute to the growing understanding of MIS-N and underscore the need for ongoing research to define optimal diagnostic criteria and treatment protocols.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Atzrodt CL, Maknojia I, McCarthy RDP, Oldfield TM, Po J, Ta KTL, et al. Guide to COVID-19: a global pandemic caused by the novel coronavirus SARS-CoV-2. FEBS J. 2020 Sep;287(17):3633-50. doi: 10.1111/febs.15375.
Dhama K, Khan S, Tiwari R, Sircar S, Bhat S, Malik YS, et al. Coronavirus Disease 2019-COVID-19. Clin Microbiol Rev. 2020;33(4):e00028-20. doi: 10.1128/CMR.00028-20.
Rawat M, Chandrasekharan P, Hicar MD, Lakshminrusimha S. COVID-19 in Newborns and Infants-Low Risk of Severe Disease: Silver Lining or Dark Cloud?. Am J Perinatol. 2020;37(8):845–9. doi: 10.1055/s-0040-1710512.
El-Hor N, Adams M. Pediatric Rheumatologic Effects of COVID-19. Pediatr Clin North Am. 2021 Oct;68(5):1011-27. doi: 10.1016/j.pcl.2021.05.002.
Kumar NP, Venkataraman A, Hanna LE, Putlibai S, Karthick M, Rajamanikam A, et al. Systemic Inflammation and Microbial Translocation Are Characteristic Features of SARS-CoV-2-Related Multisystem Inflammatory Syndrome in Children. Open Forum Infect Dis. 2021 Jul;8(7):ofab279. doi: 10.1093/ofid/ofab279.
Molloy EJ, Nakra N, Gale C, Dimitriades VR, Lakshminrusimha S. Multisystem inflammatory syndrome in children (MIS-C) and neonates (MIS-N) associated with COVID-19: optimizing definition and management. Pediatric research. 2023 May;93(6):1499-508.
McCarty KL, Tucker M, Lee G, Pandey V. Fetal Inflammatory Response Syndrome Associated With Maternal SARS-CoV-2 Infection. Pediatrics. 2021 Apr;147(4):e2020010132. doi: 10.1542/peds.2020-010132.
Son MB, Burns JC, Newburger JW. A new definition for multisystem inflammatory syndrome in children. Pediatrics. 2023 Mar 1;151(3):e2022060302.
Dhooria GS, Kakkar S, Pooni PA, Bhat D, Bhargava S, Arora K, et al. Comparison of Clinical Features and Outcome of Dengue Fever and Multisystem Inflammatory Syndrome in Children Associated With COVID-19 (MIS-C). Indian Pediatr. 2021 Oct;58(10):951-4. PMID: 34302327; PMCID: PMC8549585.
Gupta N, Talathi S. Factors Differentiating Multisystem Inflammatory Syndrome in Children (MIS-C) From Severe/Critical COVID-19 Infection in Children. Indian Pediatr. 2022 Feb;59(2):120-4. PMID: 34553691; PMCID: PMC8913231.
Pawar R, Gavade V, Patil N, Mali V, Girwalkar A, Tarkasband V, et al. Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Prenatal Maternal SARS-CoV-2: A Case Series. Children (Basel). 2021 Jul;8(7). PMID: 34356552; PMCID: PMC8305422.
Tolunay O, Celik U, Arslan I, Orgun A, Demir H, Demir O, et al. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: A Case Series Experience in a Tertiary Care Hospital of Southern Turkey. J Trop Pediatr. 2021;67(2). PMID: 34028528; PMCID: PMC8194521.
Shaiba LA, Hadid A, Altirkawi KA, Bakheet HM, Alherz AM, Hussain SA, et al. Case Report: Neonatal Multi-System Inflammatory Syndrome Associated With SARS-CoV-2 Exposure in Two Cases From Saudi Arabia. Front Pediatr. 2021;9:652857. PMID: 34055690; PMCID: PMC8158157.
Lee J, Kim BJ, Cho KS, Rhim JW, Lee SY, Jeong DC. Similarities and differences between multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease shock syndrome. Children. 2023 Sep 8;10(9):1527.
Khaund Borkotoky R, Banerjee Barua P, Paul SP, Heaton PA. COVID-19-Related Potential Multisystem Inflammatory Syndrome in Childhood in a Neonate Presenting as Persistent Pulmonary Hypertension of the Newborn. Pediatr Infect Dis J. 2021 Apr;40(4):e162-4. PMID: 33464010.
Mansour Ghanaie R, Karimi A, Pourmoghaddas Z, Armin S, Fahimzad SA, Fallah F, et al. An Algorithmic Approach to Management of COVID-19 Associated Multisystem Inflammatory Syndrome in Children. Arch Pediatr Infect Dis. 2021;9(1). doi: 10.5812/pedinfect.110479.
Alcock J, Masters A. Cytokine storms, evolution and COVID-19. Evol Med Public Health. 2021;9(1):83-92. PMID: 34552755; PMCID: PMC7928963.
Ranjbar K, Moghadami M, Mirahmadizadeh A, Fallahi MJ, Khaloo V, Shahriarirad R, et al. Methylprednisolone or dexamethasone, which one is superior corticosteroid in the treatment of hospitalized COVID-19 patients: a triple-blinded randomized controlled trial. BMC Infect Dis. 2021;21(1):337. PMID: 33838657; PMCID: PMC8035859.
Gharebaghi N, Nejadrahim R, Mousavi SJ, Sadat-Ebrahimi SR, Hajizadeh R. The use of intravenous immunoglobulin gamma for the treatment of severe coronavirus disease 2019: a randomized placebo-controlled double-blind clinical trial. BMC Infect Dis. 2020;20(1):786. PMID: 33087047; PMCID: PMC7576972.
Godfred-Cato S, Tsang CA, Giovanni J, Abrams J, Oster ME, Lee EH, et al. Multisystem Inflammatory Syndrome in Infants <12 months of Age, United States, May 2020-January 2021. Pediatr Infect Dis J. 2021 Jul;40(7):601-5. PMID: 33872279; PMCID: PMC8408805.
Health Toronto Child & Family Network. Guideline for the prevention of bronchopulmonary dysplasia and assessment of evolving bronchopulmonary dysplasia. 2019.
Ko JJ, Wu C, Mehta N, Wald-Dickler N, Yang W, Qiao R. A Comparison of Methylprednisolone and Dexamethasone in Intensive Care Patients With COVID-19. J Intensive Care Med. 2021 Jun;36(6):673-80. PMID: 33632000.