Case no
|
Age of Presentation / Sex / Birth weight / Gestation
|
Maternal Antenatal COVID 19 status
|
Neonatal COVID 19 status
|
Neonatal serology
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Clinical findings
|
Investigations
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Treatment
|
Outcome
|
Any alternative explanations for this presentation
|
Categorization
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MOST LIKELY MIS – N
|
Case 1
|
Day 1 (At birth) / Male / 1500 gram / Preterm (32 weeks)
|
History of COVID absent
|
NA
|
IgG +ve
(10.3)
|
Respiratory distress
Shock (Hypotension)
Encephalopathy
|
Leukocytopenia (1100) Thrombocytopenia (79,000)
Elevated Ddimer, Ferritin (3412), PROBNP (>35,000), LDH (4452)
Blood culture -ve
Echo – LV dysfunction
|
Ventilation
Cardiac support (Dobutamine, Epinephrine)
Antibiotics
|
Death
|
-
|
Most likely
MIS-N
|
Case
2
|
Day 5 / Male / 2520 gram / Term
|
History of COVID present
RTPCR +ve
|
NA
|
IgG +ve
(9.32)
|
Respiratory distress
Shock (Hypotension)
refusal of feeds, lethargy
|
Elevated TropT (8.92), PROBNP (>30,000), LDH (588)
Blood culture -ve
Echo – Borderline LV dysfunction, normal coronaries
|
Respiratory support (HFNC)
Cardiac support (Epinephrine)
Antibiotics (7 days)
Steroids (Methylprednisolone for 7 days, Prednisolone for 28 days)
IVIG
Aspirin
|
Discharge
|
-
|
Most likely
MIS-N
|
Case 3
|
Day 1 / Male / 2600 gram / Preterm (34 1/7 weeks)
|
History of COVID absent
RTPCR -ve
IgG +ve
(32.53)
|
RTPCR
-ve
|
IgG +ve
(> 1)
|
Respiratory distress
Shock (Hypotension)
Lethargy
|
Elevated Procalcitonin (8.36), Ddimer (2445), Ferritin (279.67), PROBNP (34,308)
Blood culture -ve
Echo – LV dysfunction, PPHN
|
Ventilation
Cardiac support (Epinephrine, Milrinone)
Antibiotics
Steroids (Methylprednisolone for 10 days)
IVIG
|
Discharge
|
-
|
Most likely
MIS-N
|
Case 4
|
Day 2/ Female / 1900 gram / 37 week
|
History of COVID present
RTPCR -ve
IgG +ve
(8.4)
|
NA
|
IgG +ve
(3.4)
|
Fever, Refusal to feed, Apnea, Hypoglycaemia, Lethargy, Seizure
|
Elevated D-dimer (253), PROBNP (9541), CRP 6.0(at presentation)
Blood culture -ve
Echo – Biventricular dysfunction
Repeat CRP 125 (3 days later)
USG Brain -normal
|
Oxygen
Antibiotics
Inotrope (dobutamine and Noradrenaline)
Steroids + IVIG (Methylprednisolone)
|
Discharge
|
-
|
Most likely
MIS-N
|
Case 5
|
1 Month / Female / 2200 gram / Term
|
Covid
IgM -ve
IgG +ve
(663)
|
RT PCR
-ve
|
Covid IgG +ve (495)
|
Respiratory distress, Shock Hypoglycaemia
|
CRP (3.3)
CBP – Normal
Elevated Procalcitonin (18), D dimer (29,624), Ferritin (3,234)
Echo – Severe Biventricular Dysfunction (LVEF 30%)
Dilated LMCA= 1.7mm (Z= 2.53)
Moderate pericardial effusion
CSF – Normal
|
IV Antibiotics
(Inj Meropenam, Inj Amikacin)
Inotropes
(Inj Noradrenaline, Inj Dobutamine, Inj Milirone, Inj Vasopressin)
Inj Methylprednisolone
Inj IVIG
(@2g/kg/day)
|
Death
|
-
|
Most likely
MIS-C
|
POSSIBLY MIS – N
|
Case 6
|
Day 5 / Female / 3200 gram / Term
|
History of COVID present RTPCR +ve
|
RTPCR
-ve
|
IgG +ve
(7.89)
|
Fever, refusal of feeds, lethargy & vomiting
|
Thrombocytopenia (1,21,000),
Elevated CRP (9.47),
Ddimer (570), Ferritin (519),
IL6 (4.67)
Blood culture -ve
|
Antibiotics (5 days)
Steroids (Prednisolone for 4 weeks)
|
Discharge
|
- Culture negative sepsis
|
Possibly MIS-N*
|
Case 7
|
Day 1 (6 hours of life) / Male / 2340 gram / Term
|
History of COVID present
IgM +ve
IgG +ve
|
RTPCR
-ve
|
IgG +ve
(4.76)
|
Asymptomatic
Cardiac murmur
|
Elevated Ddimer (22,942), Ferritin (390), PROBNP (7,635), LDH (3,466)
Blood culture -ve
Echo – LV dysfunction
|
Steroids (Methylprednisolone for 3 days)
IVIG
|
Discharge
|
- Transitional circulation – shock
- Birth asphyxia (Unclear history)
|
Possibly MIS-N*
|
Case 8
|
Day 1 (At birth) / Male / 2430 gram / Preterm (34 weeks)
|
History of COVID present
RTPCR +ve
|
RTPCR
-ve
|
IgM +ve (29.7)
IgG +ve
(1.13)
|
Respiratory distress
|
Elevated Ddimer (1269), PROBNP (774), LDH (595)
Deranged coagulation profile
Blood culture -ve
Echo – LV dysfunction
|
Surfactant Ventilation
Cardiac support (Epinephrine)
Antibiotics (7 days)
Steroids (Methylprednisolone for 7 days, Prednisolone for 7 days)
IVIG
Aspirin
|
Discharge
|
- Respiratory Distress Syndrome
- Birth asphyxia (Unclear history)
- Intrauterine infection with COVID (RTPCR Neg)
|
Possible MIS-N
|
Case 9
|
Day 1 (4 hours of life) / Male / 2500 gram / Preterm (34 3/7 weeks)
|
History of COVID symptoms present
RTPCR +ve
|
RTPCR
-ve
|
IgG +ve
(168)
|
Respiratory distress
|
Elevated Ddimer (1077), PROBNP (9726)
Blood culture -ve
Echo – LV normal, PPHN
|
Ventilation
Cardiac support (Sildenafil)
Antibiotics
Steroids (Methylprednisolone)
|
Discharge
|
- Respiratory Distress Syndrome
- Transitional circulation – shock
- Early onset sepsis
|
Possibly MIS-N
|
Case 10
|
Day 18 / Male / 2860 gram / Term
|
History of COVID symptoms present
RTPCR +ve
|
RTPCR
-ve
|
IgG +ve
(18)
|
Fever, refusal of feeds, lethargy & Tachycardia
|
Thrombocytosis (5,55,000)
Elevated CRP (180), Procalcitonin (7.1), Ferritin (1560)
Deranged coagulation profile
Blood culture -ve
Echo – normal
|
Antibiotics (5 days)
No steroids.
|
Discharge
|
- Late onset sepsis
|
Possibly MIS-C
|
Case 11
|
Day 9 / Female / 3230 gram / Term
|
History of COVID present
IgM +ve
IgG +ve
|
RTPCR
-ve
|
IgG +ve
(9)
|
Fever, refusal of feeds, lethargy & Tachycardia
|
Leucocytosis (28,600)
Thrombocytosis (6,30,000)
Elevated CRP (38), Procalcitonin (8.2), Ferritin (1200)
Deranged coagulation profile
Blood culture -ve
Echo – normal
|
Antibiotics (5 days)
Steroids (Dexamethasone for 10 days)
|
Discharge
|
- Late onset sepsis
|
Possibly MIS-N
|
Case 12
|
Day 28 / Male / 2950 gram / Term
|
History of COVID absent
IgM +ve
IgG +ve
|
RTPCR
-ve
|
IgG +ve
(177)
|
Fever, refusal of feeds & Tachycardia
|
Leucocytosis (18,700)
Thrombocytosis (4,65,000)
Elevated CRP (96), Procalcitonin (3.6), Ferritin (980)
Deranged coagulation profile
Blood culture -ve
|
Antibiotics (5 days)
|
Discharge
|
- Late onset sepsis
|
Possibly MIS-C
|
Case 13
|
Day 15/ Male / 2400 gram / Term
|
History of COVID present
RTPCR -ve
|
NA
|
IgG +ve
(22)
|
Fever, Refusal to feed, Apnea, ,Lethargy
|
Elevated D-dimer (570), PROBNP (2469)
Blood culture -ve
Echo – LV Normal
CRP 0.5, Ferritin 460
LDH 3080, SGPT 110/SGOT 407, Total billi 13.59, direct 0.83, USG Brain – normal
|
oxygen
Antibiotics
Steroids (Methylprednisolone)
|
Discharge
|
- Viral Pneumonia
- Sepsis
|
Possible MIS-C
|
Case 14
|
Day 26/ Male / 3400 gram / Term
|
History of COVID present
RTPCR + ve
|
RTPCR
-ve
|
IgG +ve
(229.9)
|
Respiratory distress, Fever, Refusal to feed, Lethargy
|
Elevated CRP (236), D-dimer (860), PROBNP (857)
Blood culture -ve
Echo – LV normal
CBC (Normal)
|
Oxygen
Antibiotics
Steroids (Methylprednisolone)
|
Discharge
|
- Viral Pneumonia
- Sepsis
|
Possibly MIS-C
|
UNLIKELY MIS – N
|
Case 15
|
Day 1 / Male /
3300 gram / 37 weeks
|
Covid
IgM +ve
(1.40)
IgG +ve (680.4)
|
RT PCR
-ve
|
Covid IgM -ve IgG +ve (495)
|
Respiratory distress on admission, Fever from day 3 of life
|
Elevated CRP (71.5), Procalcitonin (173)
2D Echo – Normal
CSF – Normal
Blood Culture - Negative
|
IV Antibiotics
(Inj Meropenam, Inj Amikacin)
Steroids
|
Discharged
|
- Early onset sepsis
|
Unlikely MIS-N
|
Case 16
|
Day 7 / Male / 1700 gram / Preterm (36 4/7 weeks)
|
History of COVID absent
IgM +ve
IgG +ve
|
NA
|
IgG +ve
(2.73)
|
Respiratory distress
Shock (Hypotension)
Ascites
|
Thrombocytopenia (62,000)
Elevated CRP (24.95), Ddimer (1917), Ferritin (1450), PROBNP (6864)
Deranged coagulation profile
Blood culture – Klebsiella
Echo – LV dysfunction
|
Surfactant Ventilation
Cardiac support (Epinephrine)
Antibiotics (7 days)
Steroids (Methylprednisolone for 7 days, Prednisolone for 7 days)
IVIG
Aspirin
|
Discharge
|
- Late onset sepsis
- Necrotizing enterocolitis
- Hepatitis
|
Unlikely MIS-N
|
Case 17
(Twin I)
|
Day 1 Male/ 1400 gram /
28 1/7 weeks
|
RTPCR + ve
|
RTPCR
-ve
|
IgG +ve
(27)
|
Respiratory distress,
No fever
|
CBC, PCT, CRP normal
|
Oxygen, HFNC
Antibiotics
Steroids
|
Discharge
|
Preterm RDS
|
Unlikely MIS-N
|
Case 18
(Twin II)
|
Day 1 Male/ 1400 gram /
28 1/7 weeks
|
RTPCR + ve
|
RTPCR
-ve
|
IgG +ve
(29)
|
Respiratory distress,
No fever
|
CBC, PCT, CRP normal
|
Oxygen, CPAP
Antibiotics
Steroids
|
Discharge
|
Preterm RDS
|
Unlikely MIS-N
|
Case 19
|
Day 2 / Male / 3200 gram / Term
|
RTPCR + ve
|
RTPCR
-ve
|
IgG +ve
(39)
|
Fever
Convulsion
|
Elevated D-dimer
Blood culture -ve
CSF-Normal
Echo – LV normal
CRP- elevated, CBC (Normal),
Electrolytes- Normal
|
IV Antibiotics
Methylprednisolone for 3 days
IVIG X 2 doses
|
Discharge
|
Early onset sepsis
Neonatal seizures
|
Unlikely MIS-C
|
Case 20
|
1 Month / Male / 2600 gram / Term
|
Covid
IgM -ve
IgG +ve (4094)
|
RT PCR
-ve
|
Covid IgG +ve
(220.5)
|
Excessive crying, right sided submandibular swelling
|
Leucocytopenia (3,450)
Thrombocytopenia (1,27,000)
CRP (5.8)
USG Neck (Parotitis)
Echo – Prominent RCA (1.50) (Z=+1.77)
|
IV Antibiotics
(Inj Taxim, Inj Amikacin)
|
Discharged
|
Parotitis
|
Unlikely MIS-C
|
RTPCR – Reverse Transcriptase-Polymerase Chain Reaction; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus-2; IG-Immunoglobulins; IgG positive - >1.00 S/CO index; TLC- Total leucocyte count, ANC-Absolute Neutrophil Count; CRP- C reactive protein (mg/L); PCT - Procalcitonin (ng/mL); D Dimer (> 200 ng/ml); Ferritin (> 260 ng/ml in term > 200 ng/ml in preterm); IL6 - Interleukin 6; PT – Prothrombin Time(seconds); APTT – Activated Plasma Thromboplastin Time(Seconds); PRO-BNP – Pro B-type natriuretic peptide (levels of > 700 pg/ml); LDH - lactate dehydrogenase (> 450 U/l)
Left Ventricular (LV) Dysfunction - Left Ventricular(LV) ejection fraction(EF) <55% and fractional shortening (FS) < 26% on functional echocardiography
|