Multisystem Inflammatory Syndrome In Neonates Associated With SARS-CoV2 infection- A case series.

Abstract Multisystem inflammatory syndrome(MIS) in children (MIS-C) associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) is well recognised in children, however, rarely reported in newborns. We describe a case series of 20 neonates who were diagnosed as MIS in neonates (MIS-N). We grouped cases into three categories as Most likely MIS(5), Possible MIS(9) and Unlikely MIS(6). All neonates had high titres of SARS CoV 2 IgG antibodies and were negative for SARS CoV 2 antigens. The most common clinical findings noted in Most Likely MIS neonates were respiratory distress (4/5), shock with hypotension (4/5) and encephalopathy (4/5). Inflammatory markers like CRP (1/5), Procalcitonin (1/5), Ferritin (3/5), D-dimer (4/5) and LDH (2/5) were found to be elevated, and four of them had significantly high levels of proBNP. The majority of them (4/5) responded to immunomodulators, three discharged home and two neonates died. The most common clinical findings in Possible MIS infants were fever (6/9), respiratory distress (3/9), refusal to feeds (6/9), lethargy (5/9) and tachycardia (3/9). ProBNP as a marker of cardiac dysfunction was noted to be elevated in five infants correlating with Echocardiography in two. All infants in this group responded to immunomodulators.MIS-N manifested as a milder disease in term neonates than preterms, where it was a more severe presentation with cardiac dysfunction. The diagnosis of MIS-N can be challenging and requires a high index of suspicion and early, proactive management. However, it is also important to be cautious of incorrect or overdiagnosis of this condition during the current pandemic.