Download PDF
Am J Perinatol 2021; 38(06): 632-636
DOI: 10.1055/s-0041-1726318
Short Communication

Presumptive Neonatal Multisystem Inflammatory Syndrome in Children Associated with Coronavirus Disease 2019

Abhay A. Divekar 
1   Department of Pediatrics, Rocky Mountain Hospital for Children at Presbyterian/St. Luke, HealthONE, Denver, Colorado
2   Rocky Mountain Pediatric Cardiology, Denver, Colorado
,
Pisespong Patamasucon
1   Department of Pediatrics, Rocky Mountain Hospital for Children at Presbyterian/St. Luke, HealthONE, Denver, Colorado
3   Rocky Mountain Pediatric Infectious Disease Consultants, Denver, Colorado
,
Joshua S. Benjamin
1   Department of Pediatrics, Rocky Mountain Hospital for Children at Presbyterian/St. Luke, HealthONE, Denver, Colorado
4   MEDNAX Health Solutions Partner, Neonatology, Denver, Colorado
› Author Affiliations Funding This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.
› Further Information
    Permissions and Reprints

Abstract

Objective The study aimed to alert the neonatal community to the possibility of multisystem inflammatory syndrome in children (MIS-C) like disease in critically ill neonates born to mothers with coronavirus disease 2019 (COVID-19).

Study Design Diagnosis of MIS-C like disease was pursued after echocardiography showed severely depressed ventricular function and pathological coronary artery dilation in the setting of medically refractory multisystem organ failure and maternal COVID-19 infection. The neonate did not respond to standard medical therapy, and there was no alternative disease that could explain the clinical course. High index of clinical suspicion coupled with low risk of intravenous immunoglobulin (IVIG) prompted us to pursue IVIG administration even though the neonate did not meet classic criteria for MIS-C.

Result Following treatment with IVIG, there was rapid clinical improvement. Ventricular function improved within 15 hours and coronary artery dilation resolved in 8 days. There was no recurrence of disease during follow-up.

Conclusion COVID-19 associated MIS-C like disease has not been well described in neonates. As typical features may be conspicuously absent, a high index of suspicion is warranted in critically ill neonates born to mothers with COVID-19. Echocardiography may provide critical diagnostic information and narrow the differential diagnosis.

Key Points

  • COVID-19 associated MIS-C can present in neonates.

  • Echocardiography is helpful in raising suspicion for MIS-C in neonates.

  • Consider MIS-C in the differential diagnosis of ill neonates born to mothers with COVID-19.

Keywords

multisystem inflammatory syndrome in children - COVID-19 - neonate - severe acute respiratory syndrome coronavirus 2 - intravenous immunoglobulin


Publication History

Received: 02 January 2021

Accepted: 09 February 2021

Article published online:
23 March 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395 (10237): 1607-1608
    CrossrefPubMedGoogle Scholar
  • 2 Henderson LA, Canna SW, Friedman KG. et al. American College of Rheumatology Clinical Guidance for pediatric patients with multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 and hyperinflammation in COVID-19. version 2. Arthritis Rheumatol 2020; DOI: 10.1002/art.41616.
    CrossrefPubMedGoogle Scholar
  • 3 CDC Health Alert Network Mulitsystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease. 2019 (COVID-19). Accessed January 2, 2021 at: https://emergency.cdc.gov/han/2020/han00432.asp
    PubMedGoogle Scholar
  • 4 Lin IC, Hsu TY, Tain YL. et al. Coronary dilatation and endothelial inflammation in neonates born to mothers with preeclampsia. J Pediatr 2021; 228: 58-65.e3
    CrossrefPubMedGoogle Scholar
  • 5 Hangai M, Kubota Y, Kagawa J. et al. Neonatal Kawasaki disease: case report and data from nationwide survey in Japan. Eur J Pediatr 2014; 173 (11) 1533-1536
    CrossrefPubMedGoogle Scholar
  • 6 Altammar F, Lang B. Kawasaki disease in the neonate: case report and literature review. Pediatr Rheumatol Online J 2018; 16 (01) 43
    CrossrefPubMedGoogle Scholar
  • 7 Zhu H, Wang L, Fang C. et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9 (01) 51-60
    CrossrefPubMedGoogle Scholar
  • 8 Dufort EM, Koumans EH, Chow EJ. et al; New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem inflammatory syndrome in children in New York state. N Engl J Med 2020; 383 (04) 347-358
    CrossrefPubMedGoogle Scholar
  • 9 Morris SB, Schwartz NG, Patel P. et al. Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection - United Kingdom and United States, March-August 2020. Morb Mortal Wkly Rep 2020; 69 (40) 1450-1456
    CrossrefPubMedGoogle Scholar
  • 10 Alsaleem M. Intravenous immune globulin uses in the fetus and neonate: a review. Antibodies (Basel) 2020; 9 (04) 60
    CrossrefPubMedGoogle Scholar
  • 11 Rostad CA, Chahroudi A, Mantus G. et al. Quantitative SARS-CoV-2 serology in children with multisystem inflammatory syndrome (MIS-C). Pediatrics 2020; 146 (06) e2020018242
    CrossrefPubMedGoogle Scholar
  • 12 Ciobanu AM, Dumitru AE, Gica N, Botezatu R, Peltecu G, Panaitescu AM. Benefits and risks of IgG transplacental transfer. Diagnostics (Basel) 2020; 10 (08) 583
    CrossrefPubMedGoogle Scholar
  • 13 Zeichner SL, Cruz AT. Multisystem inflammatory syndrome in children and SARS-CoV-2 serology. Pediatrics 2020; 146 (06) e2020032888
    CrossrefPubMedGoogle Scholar