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Article

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

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Department of Pediatrics, Dr. D Y Patil Medical College Hospital and Research Institute, Kolhapur 416003, MH, India
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Masai Children’s Hospital, Kolhapur 416002, MH, India
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NICE Advanced Neonatal Care Centre and Children’s Clinic, Kolhapur 416008, MH, India
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Ratna NICU, Kolhapur 416003, MH, India
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Department of Pediatrics, Apple Saraswati Multispeciality Hospital, Kolhapur 416003, MH, India
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Niramay Pediatric Nursing Home and Eye Care Centre, Kolhapur 416001, MH, India
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Samarth Nursing Home, Kolhapur 416002, MH, India
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UC Davis Children’s Hospital, Sacramento, CA 95817, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Bernhard Schwaberger
Children 2021, 8(7), 572; https://doi.org/10.3390/children8070572
Received: 4 June 2021 / Revised: 25 June 2021 / Accepted: 30 June 2021 / Published: 2 July 2021
(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns)
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. View Full-Text
Keywords: neonate; multisystem inflammatory syndrome in children (MIS-C); anti SARS-CoV-2 antibodies; COVID-19 neonate; multisystem inflammatory syndrome in children (MIS-C); anti SARS-CoV-2 antibodies; COVID-19
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MDPI and ACS Style

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 2021, 8, 572. https://doi.org/10.3390/children8070572

AMA Style

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. 2021; 8(7):572. https://doi.org/10.3390/children8070572

Chicago/Turabian Style

Pawar, Ravindra, Vijay Gavade, Nivedita Patil, Vijay Mali, Amol Girwalkar, Vyankatesh Tarkasband, Sanjog Loya, Amit Chavan, Narendra Nanivadekar, Rahul Shinde, Uday Patil, and Satyan Lakshminrusimha. 2021. "Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Prenatal Maternal SARS-CoV-2: A Case Series" Children 8, no. 7: 572. https://doi.org/10.3390/children8070572

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