Presumptive Neonatal Multisystem Inflammatory Syndrome in Children Associated with Coronavirus Disease 2019
Presumptive Neonatal Multisystem Inflammatory Syndrome in Children Associated with Coronavirus Disease 2019
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DOI：
10.1055/s-0041-1726318
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发表时间：
2021-03-23
影响因子：
2
通讯作者：
Benjamin, Joshua S.
中科院分区：
文献类型：
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作者：
Divekar, Abhay A.;Patamasucon, Pisespong;Benjamin, Joshua S.
目的为提高新生儿社区对冠状病毒病(新冠肺炎)母亲所生危重新生儿发生多系统炎症综合征样疾病的可能性的警觉。在超声心动图显示在药物难治性多系统器官衰竭和母亲新冠肺炎感染的情况下，超声心动图显示严重的心功能抑制和病理性冠状动脉扩张后，进行了研究设计的诊断。新生儿对标准的药物治疗没有反应，也没有其他疾病可以解释临床过程。较高的临床怀疑指数和较低的静脉注射免疫球蛋白(IVIG)风险促使我们继续使用IVIG治疗，即使新生儿不符合经典的MI-C标准。心功能在15小时内改善，冠状动脉扩张在8天内消失。结论新冠肺炎相关的MISC类疾病在新生儿中尚未得到很好描述。由于典型特征可能明显缺失，患有新冠肺炎的母亲生下的危重新生儿有理由高度怀疑。超声心动图可以提供关键的诊断信息，缩小鉴别诊断的范围。
Objective The study aimed to alert the neonatal community to the possibility of multisystem inflammatory syndrome in children (MIS-C) like disease in critically ill neonates born to mothers with coronavirus disease 2019 (COVID-19).Study Design Diagnosis of MIS-C like disease was pursued after echocardiography showed severely depressed ventricular function and pathological coronary artery dilation in the setting of medically refractory multisystem organ failure and maternal COVID-19 infection. The neonate did not respond to standard medical therapy, and there was no alternative disease that could explain the clinical course. High index of clinical suspicion coupled with low risk of intravenous immunoglobulin (IVIG) prompted us to pursue IVIG administration even though the neonate did not meet classic criteria for MIS-C.Result Following treatment with IVIG, there was rapid clinical improvement. Ventricular function improved within 15 hours and coronary artery dilation resolved in 8 days. There was no recurrence of disease during follow-up.Conclusion COVID-19 associated MIS-C like disease has not been well described in neonates. As typical features may be conspicuously absent, a high index of suspicion is warranted in critically ill neonates born to mothers with COVID-19. Echocardiography may provide critical diagnostic information and narrow the differential diagnosis.