To the Editor: Newborns presenting with features of MIS-C as a complication of COVID-19, can be subgrouped as MIS-N (multisystem inflammatory syndrome in newborns). Transmission of maternal COVID-19 to the fetus can lead to neonates presenting with inflammatory features [1, 2]. We report a preterm baby of COVID-19 mother with nonim- mune hydrops.
Mother tested COVID-19 positive at 34 wk gestation, with no known comorbidities. Antenatal scans were normal in the first and second trimesters. Obstetric scan revealed absent diastolic flow in umbilical arteries along with fetal right ven- tricular dilation, fluid collection in peritoneal, and bilateral pleural cavities suggestive of hydrops fetalis. Her pregnancy was terminated prematurely after 2 doses of dexamethasone.
Baby required intubation at birth (APGAR – 3/10, 5/10); extubated onto oxygen prongs by first hour of life. Persis- tent tachycardia, S3 gallop with hepatomegaly suggested cardiac overload; started on dobutamine infusion (10 mcg/ kg/min) with furosemide (1 m/kg/dose q6h). Elevated CRP (14.29 mg/L) prompted initiation of antibiotics. Cardiomeg- aly on radiograph and abdominal free fuid on ultrasound were noted.
SARS-CoV-2 RT-PCR swabs sent on day 1, 5 were negative. Anti-COVID-19 antibodies were elevated (Total – 37.4 IU/L, IgG – 0.77 IU/L) implying COVID-19 infection in utero. 2D-echocardiography revealed pulmonary hyperten- sion, biventricular hypertrophy, severe mitral and tricuspid regurgitation with EF=35%. Ferritin (700 ng/mL) and LDH (2115.6 U/L) were also elevated. Baby improved by day 5,with EF=58% and oxygen support. She started accepting pallada feeds by day 7 and was discharged on day 17.
Amiraskari et al. and Krasniqi et al. have reported similar congenital myocarditis and nonimmune hydrops with mater- nal COVID-19, respectively [3, 4]. Early recognition and supportive care improves neonatal survival. Role of IVIG and steroids in MIS-N needs evaluation. This case highlights the possibility of congenital SARS-CoV-2 infection present- ing as fetal hydrops.
1. McCarty KL, Tucker M, Lee G, Pandey V. Fetal inflammatory response syndrome associated with maternal SARS-CoV-2 infection. Pediatrics. 2021;147:e2020010132.
2. Dong L, Tian J, He S, et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020;323:1846–8.
3. Amiraskari R, Sayarifard E, Kharrazi H, Naserfar N, Sayarifard A. Neonatal SARS-CoV-2 infection and congenital myocarditis: a case report and literature review. Arch Pediatr Infect Dis. 8:e103504.
4. Krasniqi F, Pistulli E, Gashi AM, Krasniqi I. Non-immunologic hydrops fetalis and coronavirus disease (COVID-19) – a case report. Ro J Pediatr. 2021;70.