What is Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome)?

In March 2020, the World Health Organization declared a global pandemic due to the outbreak of COVID-19. This illness is caused by the SARS-CoV-2 virus and can cause severe breathing difficulties in people of all ages. It tends to cause serious respiratory issues more commonly in adults, while children typically experience milder symptoms and recover more easily. However, it is important to note that newborns are not commonly infected with this virus.

The reason newborns are less likely to get COVID-19 is believed to be due to the low presence of specific receptors, called angiotensin-converting enzyme two receptors, found in the lining of the nose. These receptors are thought to be the main entry point for the virus into the human body. Yet, some cases have shown severe inflammation, shock and organ failure in both newborns and older children who had previously been infected with the virus and then developed antibodies against it. This has led to the identification of a different illness related to COVID-19 in children known as multisystem inflammatory syndrome associated with covid-19 (MIS-C).

MIS-C, also known as pediatric multisystem inflammatory syndrome (PMIS) or pediatric inflammatory, multisystem syndrome (PIMS), is diagnosed when a child has a fever that lasts for a while, signs of inflammation in their body, and evidence of multiple organs not working properly. This can happen with or without a previous confirmed case of COVID-19.

Other illnesses with similar signs and symptoms must be ruled out before a child can be diagnosed with MIS-C. The condition is considered to be a consequence of the immune system’s response to COVID-19, and typically starts to show symptoms about 4 to 5 weeks after exposure to the virus. The symptoms and severity of MIS-C can vary widely, ranging from no symptoms at all to severe, life-threatening organ failure. Although it is rare, this condition can also affect newborns and infants.

What Causes Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome)?

Most cases of newborn babies getting COVID-19 are caused by what’s called horizontal transmission, or catching the virus from someone or something in their environment. There have been some cases where it’s thought that the virus was passed from a pregnant mother to her baby, a process known as vertical transmission. However, recent studies suggest that vertical transmission may be rare. This may be due to low levels of certain receptors, which the virus needs in order to enter cells, in the placenta.

MIS-C, or multisystem inflammatory syndrome in children, is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal organs. This can occur in some children and teenagers who have been infected with the virus that causes COVID-19. While we don’t know the exact reason behind why MIS-C happens, it is believed to be caused by an overreactive response from the body’s immune system following a COVID-19 infection, rather than the virus directly damaging cells. This immune response could happen after either showing symptoms of COVID-19 or after having a silent, symptom-free COVID-19 infection. Currently, we believe there are a few possible reasons:

  1. A pregnant mother gets a COVID-19 infection and passes antibodies, which can identify and help fight the virus, to her baby during pregnancy.
  2. The virus itself passes from a pregnant mother to her baby during pregnancy, and the baby’s body produces its own antibodies.
  3. A newborn baby gets a COVID-19 infection and its body reacts after the infection by launching an immune response.

Risk Factors and Frequency for Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome)

Information on the occurrence of COVID-19 and a condition known as MIS-C in newborn babies is limited. It’s predicted that less than 1 percent of children exposed to COVID-19 will develop MIS-C. Factors that may increase the risk include a history of asthma and obesity. Nonetheless, we don’t know exactly how often MIS-C occurs in newborns.

  • The Centers for Disease Control (CDC) data suggests that only 4% of all MIS-C cases happen in infants under 1 year of age.
  • Most of the information we have about MIS-C in newborns comes from individual case reports and small series of cases.
  • In general, newborns seem to be less likely than older children to contract COVID-19 or develop MIS-C.

Signs and Symptoms of Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome)

MIS-C, or Multisystem Inflammatory Syndrome in Children, is a condition that can occur a few weeks after a young person has been exposed to COVID-19. It can present in many different ways and at different times after the exposure. For instance, it generally occurs about 4 or 5 weeks after the COVID-19 exposure. However, infants whose mothers had COVID-19 might show symptoms earlier, due to antibodies from their mothers. This can range from showing no symptoms at all to experiencing multiple organ failure. Infants might also have fever, but it’s not always present. Similarly, signs of inflammation and problems with multiple organs can help diagnose this condition.

The symptoms of MIS-C can include fever, rash, red or pink eyes (conjunctivitis), and digestive problems such as vomiting, diarrhea, and belly pain. It’s also important to note that infants may not have a fever even if they are showing signs of inflammation and issues with multiple organs.

In newborns, the symptoms can be different from those in older children due to their less mature immune systems. The symptoms in newborns can often include digestive problems and poor feeding.

  • Rash on both sides of the body, red or pink eyes, or involvement of skin, linings of mouth, throat, etc.
  • Low blood pressure, shock, or signs of heart and blood vessel problems
  • Digestive issues such as vomiting, diarrhea, belly pain
  • Breathing trouble or pneumonia
  • Problems with the brain and nerves, seizures, signs of meningitis (inflammation of the covering of the brain and spinal cord)
  • Signs of kidney problems
  • Signs of blood clotting problems

Testing for Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome)

Multisystem Inflammatory Syndrome in Children (MIS-C) is a disease related to COVID-19 exposure. Diagnosing MIS-C usually involves evaluating the patient’s symptoms, health history including possible exposure to COVID-19, and certain abnormalities in lab tests. It is also crucial to rule out other diseases with similar symptoms. Both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have provided guidelines for diagnosing MIS-C in children. However, these guidelines might not always suit newborn babies. At this point, there isn’t a universally accepted method for diagnosing this condition in newborns alone.

Lab tests for suspected MIS-C may reveal the following results:

  • Abnormal blood count, such as too many or too few white blood cells, increased neutrophils, low red blood cell count, or low platelet count
  • High levels of inflammation markers such as C-reactive protein, erythrocyte sedimentation rate, procalcitonin, and Interleukin-6
  • Increased levels of heart disease indicators like troponin or Pro-BNP
  • Signs of abnormal clotting such as delayed clotting time or a spike in D-dimer levels
  • Low levels of albumin (a protein in your blood) and sodium necessary for vital bodily functions
  • Signs of poor liver and kidney function
  • Signs of metabolic acidosis (too much acid in the body) and high lactate levels

Do keep in mind that these results may vary, particularly in newborn babies. Therefore, doctors need to be vigilant when diagnosing MIS-C in newborns. Lab tests should be done in all cases where MIS-C is suspected to check the inflammation levels and whether critical organs are working properly.

If a baby was exposed to the SARS-CoV-2 virus (that causes COVID-19 disease), this could be confirmed through real-time polymerase chain reaction (RT-PCR) or serology tests. Also, if a newborn baby tests negative yet the mother had COVID-19, this history should be factored into the diagnosis.

All newborn babies with suspected MIS-C should be tested for heart dysfunction. This is done using an electrocardiogram and an echocardiogram. Babies who have heart-harming indicators or display signs of heart disease such as low blood pressure, shock, or the need for medication to make the heart pump better are at a higher risk for heart involvements. Research has shown that heart dysfunction, pericarditis, fluid around the heart, inflammation of heart valves, and abnormalities in the arteries that supply blood to the heart have been seen in children and babies with MIS-C.

A chest X-ray or CT scan might be used to see if there’s lung involvement, looking for signs like pneumonia or accumulation of fluid around the lungs. If a baby has symptoms similar to digestive problems, an ultrasound of the abdomen may be ordered to examine the size of organs and the gall bladder, and to rule out other potential illnesses. For cases involving possible damage to the nervous system, a brain ultrasound or MRI may be required.

Treatment Options for Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome)

The treatment for neonatal MIS-C, a condition where various parts of the body become inflamed, is largely informed by how adults and older children with the condition have been treated in the past. Medications known as corticosteroids and intravenous immunoglobulin are commonly used to manage this condition and improve symptoms related to inflammation.

Research demonstrates that using both corticosteroids and intravenous immunoglobulin together often works better than using intravenous immunoglobulin alone. In some cases, where the heart isn’t working properly (referred to as cardiovascular dysfunction), additional treatments to support the heart may be necessary. Other biological medicines, such as tocilizumab, infliximab, anakinra, and interferons, have been used in cases where the disease doesn’t respond to corticosteroids and intravenous immunoglobulin. However, there isn’t a lot of data yet to support the use of these medicines for this purpose.

Broad-spectrum antibiotics, which are active against a wide variety of bacteria, are often used initially because this condition can look a lot like sepsis, a severe illness caused by the body’s response to an infection. If tests show that the condition is not sepsis and that there’s no bacterial infection, the antibiotic treatment is usually stopped. If there’s a high risk of blood clotting, preventative measures against blood clots (thromboprophylaxis) may be required.

The best way to treat this condition needs to be customized based on each patient’s unique condition and symptoms. More studies are needed to better understand the most effective treatments. It’s also important for patients to have regular check-ups after their recovery, to keep an eye out for any potential long-term effects of the disease.

The signs of MIS-C (Multisystem Inflammatory Syndrome in Children) can look like several other illnesses. The following conditions may show similar symptoms and doctors need to consider these when making a diagnosis:

  • Toxic shock syndrome
  • Macrophage activation syndrome
  • Kawasaki disease
  • Hemophagocytic lymphohistiocytosis

What to expect with Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome)

The short-term consequences of MIS-C, a health issue associated with COVID-19 in children, often depends on how seriously and extensively it affects the heart and lungs. Some studies have reported death rates for MIS-C ranging from 1% to 11%. However, if diagnosed and treated promptly, the outcomes can be positive. It is necessary to monitor infants who were exposed to COVID-19 before birth or shortly after birth over the long term, to understand any potential long-term health effects.

Possible Complications When Diagnosed with Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome)

The main complications that are often seen with MIS-C, a condition primarily affecting children, are really serious ones, like problems with breathing and heart function. There is also an increased risk for the development of prothrombotic coagulopathy, a disease where blood clots form too readily, and issues with blood clots traveling, including to the lungs.

In addition, there have been instances of other complications being reported in those with MIS-C, such as deep vein thrombosis, where clots form in the deeper veins, limb ischemia, where blood flow to limbs is reduced, and bleeding within the brain. Other reported complications have included a build-up of fluid around the heart, and sudden kidney failure.

Common Complications:

  • Difficulties with breathing
  • Heart function issues
  • Prothrombotic coagulopathy (a disease where blood clots form too readily)
  • Thromboembolic complications (issues with blood clots traveling)
  • Deep vein thrombosis (blood clots in the deeper veins)
  • Limb ischemia (reduced blood flow to limbs)
  • Bleeding within the brain
  • Pericardial effusion (a build-up of fluid around the heart)
  • Sudden kidney failure

Preventing Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome)

MIS-C, short for Multisystem Inflammatory Syndrome in Children, is a condition that is related to COVID-19, the disease caused by the new coronavirus. The symptoms and how serious it can be are still changing and being researched. By studying and recognizing how this syndrome works within the body, we might be able to find effective treatments for it. The continuously changing forms and highly contagious nature of the coronavirus causes not only the initial infection but can also lead to later health problems. As a result, we need to develop better ways to prevent these issues.

Frequently asked questions

The prognosis for Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome) can vary depending on the severity and extent of organ involvement. Some studies have reported death rates ranging from 1% to 11%. However, if diagnosed and treated promptly, the outcomes can be positive. It is important to monitor infants who were exposed to COVID-19 before or shortly after birth over the long term to understand any potential long-term health effects.

Neonatal MIS-C can occur in a few different ways: 1. A pregnant mother gets a COVID-19 infection and passes antibodies to her baby during pregnancy. 2. The virus itself passes from a pregnant mother to her baby during pregnancy, and the baby's body produces its own antibodies. 3. A newborn baby gets a COVID-19 infection and its body reacts after the infection by launching an immune response.

The signs and symptoms of Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome) can include: - Digestive problems and poor feeding - Rash on both sides of the body, red or pink eyes, or involvement of skin, linings of mouth, throat, etc. - Low blood pressure, shock, or signs of heart and blood vessel problems - Digestive issues such as vomiting, diarrhea, belly pain - Breathing trouble or pneumonia - Problems with the brain and nerves, seizures, signs of meningitis (inflammation of the covering of the brain and spinal cord) - Signs of kidney problems - Signs of blood clotting problems It's important to note that the symptoms in newborns can be different from those in older children due to their less mature immune systems.

Lab tests for Neonatal MIS-C may include: - Blood count to check for abnormalities such as too many or too few white blood cells, increased neutrophils, low red blood cell count, or low platelet count - Inflammation markers such as C-reactive protein, erythrocyte sedimentation rate, procalcitonin, and Interleukin-6 - Heart disease indicators like troponin or Pro-BNP - Clotting tests to check for abnormal clotting time or elevated D-dimer levels - Levels of albumin and sodium in the blood - Liver and kidney function tests - Metabolic acidosis and lactate levels In addition to lab tests, other diagnostic tests that may be ordered for Neonatal MIS-C include: - Real-time polymerase chain reaction (RT-PCR) or serology tests to confirm exposure to the SARS-CoV-2 virus - Electrocardiogram and echocardiogram to test for heart dysfunction - Chest X-ray or CT scan to check for lung involvement - Abdominal ultrasound to examine the size of organs and rule out other potential illnesses - Brain ultrasound or MRI for cases involving possible damage to the nervous system

Toxic shock syndrome, Macrophage activation syndrome, Kawasaki disease, Hemophagocytic lymphohistiocytosis

The side effects when treating Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome) can include difficulties with breathing, heart function issues, prothrombotic coagulopathy (a disease where blood clots form too readily), thromboembolic complications (issues with blood clots traveling), deep vein thrombosis (blood clots in the deeper veins), limb ischemia (reduced blood flow to limbs), bleeding within the brain, pericardial effusion (a build-up of fluid around the heart), and sudden kidney failure.

Pediatrician.

Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome) is predicted to occur in less than 1 percent of children exposed to COVID-19.

The treatment for Neonatal MIS-C (Pediatric Multisystem Inflammatory Syndrome) is largely informed by how adults and older children with the condition have been treated in the past. The common medications used to manage this condition and improve symptoms related to inflammation are corticosteroids and intravenous immunoglobulin. Research shows that using both corticosteroids and intravenous immunoglobulin together often works better than using intravenous immunoglobulin alone. Additional treatments may be necessary if there is cardiovascular dysfunction. Broad-spectrum antibiotics are initially used because Neonatal MIS-C can resemble sepsis, but if tests show that there is no bacterial infection, the antibiotic treatment is usually stopped. Customized treatment based on each patient's unique condition and symptoms is important, and more studies are needed to understand the most effective treatments. Regular check-ups after recovery are also important to monitor for potential long-term effects of the disease.

Neonatal MIS-C, also known as Pediatric Multisystem Inflammatory Syndrome (PMIS) or Pediatric Inflammatory, Multisystem Syndrome (PIMS), is a condition diagnosed in newborns and infants when they have a fever, signs of inflammation in their body, and evidence of multiple organs not working properly. It is considered to be a consequence of the immune system's response to COVID-19 and can range from no symptoms to severe, life-threatening organ failure.

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