Background: The coronavirus pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has swept across the globe like an indiscriminating Tsunami. Pregnant women and neonates are at serious risk to this infection, posing unique challenges in their management. Worldwide, thousands of cases of neonatal multisystem inflammatory syndrome (MIS-N) have already been reported. The lack of high-quality data has led to considerable heterogeneity in management of MIS-N. Materials and Methods:This was a prospective observational single center study carried out in the Department of Paediatrics, Krishna Institute of Medical Sciences, Karad, Maharashtra, India, for over one year. Twenty critically ill neonates of pregnant mothers who were symptomatic or asymptomatic but previously positive or exposed to SARS-COV-2 virus during current pregnancy were studied. Results:The average neonatal age of presentation was 2.3 days. 16 neonates were Covid antibody IgG positive, 1 neonate was IgM positive, and 3 neonates had both antibodies in circulation. 30% neonates had respiratory system involvement, followed by cardiac (30%), neurological (15%), gastrointestinal (10%). All neonates had elevated inflammatory biomarkers and were administered IVIG and steroid therapy. Three infant mortalities were observed. Conclusion:COVID-19 associated MIS-C like disease has not been well described in neonates. There is high suspicion that transplacental antibodies from mothers with SARS-COV-2 may cause neonatal multisystem inflammatory syndrome (MIS-N). Immunomodulation therapy may be beneficial, but further large number of studies are needed. A high index of suspicion is needed in critically ill neonates born to mothers with COVID19.

Neonatal Multisystem Inflammatory Syndrome (MIS-N)