TITLE:
Multisystem Inflammatory Syndrome-Neonate: Biochemical Parameters as Early Marker of Adverse Neurodevelopmental Outcome
AUTHORS:
Perumalsathya Sankaranarayanan, Harshitha Shanmuganathan, Devika Sanil Kumar, Lal Devayani Vasudevan Nair, Santosh Kamalakannan
KEYWORDS:
Neurodevelopment, Covid-19, Pregnancy, Multisystem Inflammatory Syndrome, Biochemical Markers, D-Dimer, HINE Score
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.12 No.5,
November
4,
2022
ABSTRACT: Background: Pregnant women and newborns are highly susceptible to Covid-19, manifesting as multisystem
inflammatory syndrome-New-born (MISC-N)
in many babies born to Covid positive mothers. The relationship between
Covid-19 infection during pregnancy and neonatal neurodevelopmental outcome, if
any, is unclear necessitating a follow-up study in this aspect. Methods: 16 babies with MIS-N, born to symptomatic Covid antibody positive mothers were
enrolled. Demographic profile, treatment details and biochemical parameters
were analyzed with neurodevelopmental follow-up. Results: 25% mothers
received 2 doses of Covid vaccine; 50% had oligohydramnios and 75% received
antenatal steroids. 87.5% were preterm of which 62.5% required surfactant with
ventilator support and 75% required ionotropic support. Significant association
was found between the antibody level and D-dimer levels with the ferritin and
LDH levels of the baby (p 0.05); gestational age with LDH and D-dimer levels (p 0.05) and
Covid antibody level of the baby vs the duration of ventilator requirement
(P-value-0.0009). D-dimer
values of babies were positively associated with both maternal antibody and
D-dimer levels. Neurodevelopmental follow-up done at 6 months of corrected
gestational age showed 37.5% were normal, 37.5% hypertonic and 25% hypotonic.
HINE score was below 60 in 62.5%.
Development assessment using Bayley-III showed a delay
in the motor domain (62.5%), cognitive domain
(56.25%) and language domain (62.5%). Conclusion: Neurodevelopmental
problems occur in babies born to Covid positive mothers and should be
stratified as “high risk”. Anticipatory guidance to prospective mothers for
preterm care should be given. Covid antibody titre and D-dimer levels may help
to predict the NICU stay, ventilator requirement and the adverse
neurodevelopmental outcomes in these babies.