Title of Case:

EARLY OUTCOMES OF THE MULTISYSTEM INFLAMMATORY SYNDROME IN INFANTS UP TO 60 DAYS OF AGE RELATED TO PRENATAL MATERNAL COVID-19 INFECTION: CASE SERIES

Background:

The aim of this study is to evaluate the Multisystem Inflammatory Syndrome in infants associated to prenatal maternal COVID-19 infection.

Case Presentation Summary:

Methods: We conduced a prospective observational study on a case series of five infants up to 60 days of age with MIS-C due to vertical transmission of SARS-CoV2 infection, admitted in Children’s Clinical Hospital Brasov between January 1^st and December 31^st 2021. The inclusion criteria were: negative RT-PCR-SARS-CoV2 test, negative IgM-SARS-CoV2 and positive IgG-SARS-CoV2 antibodies, maternal COVID-19 infection in the third trimester of pregnancy. Patients enrolled in this case series were admitted in hospital for acute common illnesses. MIS-C was a secondary finding, after performing laboratory investigations according to their family history.

Results: All the five cases were in girls born at mean gestational age of 39 weeks as AGA. Mean age on admittance was 29,2 days and acute respiratory infections were the most frequent admittance cause. CRP was negative in four patients and one patient had CRP mild increased. Ferritin was also elevated as inflammatory marker.The most significant laboratory findings related to MIS-C were the elevated levels of D-dimers, NT-pro-BNP, Troponin T and CK-MB with normal heart function evaluated by echocardiography. Two of the patients received iv immunoglobulin. The follow-up one month after discharge was checked by two patients. Their myocardial biomarkers and ferritin were still elevated, but lower than the first evidences. D-dimers levels were normalized.

Learning Points/Discussion:

Conclusion: Subclinical myocarditis is one of the early outcomes of MIS-C related to prenatal maternal COVID-19 infection, a new challenge for the pediatricians of the pandemic era.