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Multisystem inflammatory syndrome in a neonate secondary to COVID-19: a case report

INTRODUCTION AND IMPORTANCE: Multisystem inflammatory syndrome in children secondary to coronavirus disease 2019 (COVID-19) (MIS-C) is very common and may present with clinical features similar to Kawasaki disease but is rarely reported in neonates (MIS-N). Any history of maternal upper respiratory...

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Autores principales: Upadhyay, Sristi, Devkota, Sagar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10553167/
https://www.ncbi.nlm.nih.gov/pubmed/37811070
http://dx.doi.org/10.1097/MS9.0000000000001178
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author Upadhyay, Sristi
Devkota, Sagar
author_facet Upadhyay, Sristi
Devkota, Sagar
author_sort Upadhyay, Sristi
collection PubMed
description INTRODUCTION AND IMPORTANCE: Multisystem inflammatory syndrome in children secondary to coronavirus disease 2019 (COVID-19) (MIS-C) is very common and may present with clinical features similar to Kawasaki disease but is rarely reported in neonates (MIS-N). Any history of maternal upper respiratory tract infection should raise suspicion of MIS-N secondary to COVID-19 in critically ill neonates. CASE PRESENTATION: The authors present a term neonate with gradually progressive respiratory distress requiring mechanical ventilation with marked improvement after starting immunoglobulin and steroids after blood investigations revealed high IgG COVID-19 antibody titers. CLINICAL FINDINGS AND INVESTIGATION: Admitted to the Neonatal Intensive Care Unit as he received bag and mask ventilation for 30 s following delivery, he was kept under oxygen via nasal prongs; but he still had nasal flaring, subcostal retraction, and tachypnea. All the blood investigations were within normal limits except for elevated C-reactive protein. INTERVENTION AND OUTCOME: With no improvement despite oxygen via nasal prongs, he was kept under bubble continuous positive airway pressure with positive end-expiratory pressure of 5 cm of H(2)O. With no improvement even after 24 h of noninvasive ventilation, he was kept under mechanical ventilation in assisted pressure-controlled mode with a peak inspiratory pressure of 22 cm H(2)O and respiratory rate of 40 breaths/minute. As the mother gave a history of on-and-off cough for almost a month, samples were sent for COVID-19 antibodies which came out to be positive with very high titers of IgG antibodies. Intravenous steroids, immunoglobulin, and subcutaneous low molecular weight heparin were started and marked improvement was noted. The peak inspiratory pressure and FiO(2) were gradually tapered off, and he was extubated on the 10th day of mechanical ventilation. CONCLUSION: Multisystem inflammatory syndrome in neonates is rare but should always be considered in neonates with multisystem involvement and a history of maternal upper respiratory tract infection after excluding all other causes.
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spelling pubmed-105531672023-10-06 Multisystem inflammatory syndrome in a neonate secondary to COVID-19: a case report Upadhyay, Sristi Devkota, Sagar Ann Med Surg (Lond) Case Reports INTRODUCTION AND IMPORTANCE: Multisystem inflammatory syndrome in children secondary to coronavirus disease 2019 (COVID-19) (MIS-C) is very common and may present with clinical features similar to Kawasaki disease but is rarely reported in neonates (MIS-N). Any history of maternal upper respiratory tract infection should raise suspicion of MIS-N secondary to COVID-19 in critically ill neonates. CASE PRESENTATION: The authors present a term neonate with gradually progressive respiratory distress requiring mechanical ventilation with marked improvement after starting immunoglobulin and steroids after blood investigations revealed high IgG COVID-19 antibody titers. CLINICAL FINDINGS AND INVESTIGATION: Admitted to the Neonatal Intensive Care Unit as he received bag and mask ventilation for 30 s following delivery, he was kept under oxygen via nasal prongs; but he still had nasal flaring, subcostal retraction, and tachypnea. All the blood investigations were within normal limits except for elevated C-reactive protein. INTERVENTION AND OUTCOME: With no improvement despite oxygen via nasal prongs, he was kept under bubble continuous positive airway pressure with positive end-expiratory pressure of 5 cm of H(2)O. With no improvement even after 24 h of noninvasive ventilation, he was kept under mechanical ventilation in assisted pressure-controlled mode with a peak inspiratory pressure of 22 cm H(2)O and respiratory rate of 40 breaths/minute. As the mother gave a history of on-and-off cough for almost a month, samples were sent for COVID-19 antibodies which came out to be positive with very high titers of IgG antibodies. Intravenous steroids, immunoglobulin, and subcutaneous low molecular weight heparin were started and marked improvement was noted. The peak inspiratory pressure and FiO(2) were gradually tapered off, and he was extubated on the 10th day of mechanical ventilation. CONCLUSION: Multisystem inflammatory syndrome in neonates is rare but should always be considered in neonates with multisystem involvement and a history of maternal upper respiratory tract infection after excluding all other causes. Lippincott Williams & Wilkins 2023-08-16 /pmc/articles/PMC10553167/ /pubmed/37811070 http://dx.doi.org/10.1097/MS9.0000000000001178 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Case Reports
Upadhyay, Sristi
Devkota, Sagar
Multisystem inflammatory syndrome in a neonate secondary to COVID-19: a case report
title Multisystem inflammatory syndrome in a neonate secondary to COVID-19: a case report
title_full Multisystem inflammatory syndrome in a neonate secondary to COVID-19: a case report
title_fullStr Multisystem inflammatory syndrome in a neonate secondary to COVID-19: a case report
title_full_unstemmed Multisystem inflammatory syndrome in a neonate secondary to COVID-19: a case report
title_short Multisystem inflammatory syndrome in a neonate secondary to COVID-19: a case report
title_sort multisystem inflammatory syndrome in a neonate secondary to covid-19: a case report
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10553167/
https://www.ncbi.nlm.nih.gov/pubmed/37811070
http://dx.doi.org/10.1097/MS9.0000000000001178
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