key: cord-0979494-s8w9es1k
authors: Leslie, Ana Teresa; Saleh, Manar; Soni, Naharmal; Tang, Patrick; Kallem, Venkat; Tscherning, Charlotte; More, Kiran
title: Importance of establishing antibody specificity in multisystem inflammatory syndrome in newborn during the COVID‐19 pandemic
date: 2022-03-29
journal: Acta Paediatr
DOI: 10.1111/apa.16345
sha: b123b0d87e11387b404f4ab5b89353e71a63e626
doc_id: 979494
cord_uid: s8w9es1k

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Multisystem inflammatory syndrome in newborns (MIS-N) has increasingly been reported in patients with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 1,2 MIS-N can be secondary to immune-mediated injuries, due to transplacental maternal or neonatal antibodies produced during the infection.

This process is similar to multisystem inflammatory syndrome in children. 3 Transplacental transfer of maternal SARS-CoV-2 immunoglobulin G (IgG) antibodies can be protective, 4 but sometimes inutero transfer of these antibodies, concomitant other inflammatory cytokines, may trigger MIS-N. Increased viral transmission and mass vaccination have increased SARS-CoV-2 seroprevalence, and babies are increasingly being born with positive antibodies. 5 We describe a baby with multi-organ dysfunction, due to placental abruption, but confounded by SARS-CoV-2 antibodies consistent with MIS-N.

Parental consent was provided.

A male baby weighing 2,690 kg was born at 33 + 5 weeks to a primipara mother with placenta previa. She was an unvaccinated nurse, with potential exposure to SAR-CoV-2, who tested negative before labour. The baby was born vigorous, but pale, and required intubation at 11 min. His cord gas was normal, but he had low hae- The patient's severe multi-organ dysfunction was related to placental abruption, but the degree of bleeding was unclear at birth. High levels of inflammatory markers, cardiac biomarkers and mild left ventricular dysfunction on admission, during the pandemic, suggested MIS-N. He tested negative for the virus, but his mother was positive for SARS-CoV-2 IgG antibodies and his antibodies were 6 times her levels. The initial immunomodulatory treatment, due to suspected MIS-N, was stopped after we established the antigen specificity of the antibodies. The results were inconsistent with natural infection, and vaccination-derived antibodies from transfusions were suspected. The mother's serum

Multisystem inflammatory syndrome in a neonate, temporally associated with prenatal exposure to SARS-CoV-2: a case report

Multisystem Inflammatory Syndrome in Neonates (MIS-N) associated with SARS-CoV2 infection: a case series

Perinatal SARS-CoV-2 infection and neonatal COVID-19: a 2021 update

Benefits and risks of IgG transplacental transfer

Estimated US Infection-and vaccine-induced SARS-CoV-2 seroprevalence based on blood donations