Case Report of An Extreme Premature Infant with Multisystem Inflammatory Syndrome in Neonates (MIS-N)

COVID-19 pandemic hit the world hard affecting more than 500 million people. In the SARS-CoV-2 pandemic era, there has been various information on the effect of COVID-19 infected or exposed pregnant women on their neonates. SARS-CoV-2 virus causes a hyperinflammatory syndrome in neonates similar to what may be seen in multisystem inflammatory syndrome in children (MIS-C) but due to transplacental transfer of antibodies rather than a neonatal infection with COVID-19. Case reports about a new pattern of disease, called multisystem inflammatory syndrome of neonate (MIS-N), have been recently appearing. We reviewed the perinatal history, clinical features, and outcomes of a preterm neonate with features consistent with MIS-N related to maternal SARS-CoV-2 infection that was managed in Texas, United States, in 2022. The infant presented with multisystem organ failure at 12 to 15 days of life. All extensive work up for infectious causes on the neonate were negative. Her inflammatory biomarkers were elevated, and she improved with steroids and supportive treatment. The neonate’s anti-SARS-CoV-2 IgG was positive and the IgM was negative. Though rare, we speculate that maternal SARS-CoV-2 and other autoantibodies crossing the placenta caused MIS-N. Further studies and reviews are needed to evaluate pathophysiology and to further evaluate the available treatments.