Title:Multisystem Inflammatory Syndrome in a Newborn (MIS-N): Clinical
Evidence and Neurodevelopmental Outcome
Volume: 19
Issue: 2
Author(s): Zahra Jamali, Reza Sinaei*Leyla Razi
Affiliation:
- Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
Keywords:
COVID-19, SARS-CoV-2, MIS-N, MIS-C, children, neonate.
Abstract:
Background: Although coronavirus disease-2019 (COVID-19) seems to be milder in
children than in adults, children may exhibit severe multisystemic involvement, supported by growing
evidence of this incidence in neonates. This case report aimed to demonstrate an inflammatory
response syndrome in a full-term neonate born from a 35-old-year woman infected with severe
acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
Case Presentation: A full-term neonate girl with uneventful perinatal history was admitted with
mild tachypnea at the first hour of birth and gradually worsened, resulting in subsequent ventilator
support on the second day. The nasal SARS-CoV-2 real-time polymerase chain reaction (RT-PCR)
test was positive in several cessations from the time of admission until the tenth day. She revealed
cardiomegaly, a diffuse opacification of lungs in the chest radiograph, both side ventricular hypertrophy,
valvular regurgitation, and severe pulmonary hypertension on echocardiography. She underwent
treatment with surfactant, antibiotics, paracetamol, inotropes, and sildenafil, with beneficial
effects. In the lack of a positive fluid culture, she developed necrotizing enterocolitis, transaminitis,
and a generalized rash on day six. Furthermore, her mild brain edema that occurred on the second
day developed into hydrocephaly. The patient was considered MIS-N and successfully treated with
methylprednisolone pulse and intravenous immunoglobulin. She was discharged after 29 days and
followed for eight months with persistent mild hydrocephalous and possible evidence of cerebral
palsy.
Conclusion: We conclude that maternal exposure to COVID-19 may potentially be associated with
multisystem inflammation in the early neonatal period. However, this condition is relatively rare.
Immunomodulatory agents may be beneficial in this condition.
