36-week premature infant beats severe post-Covid syndrome in Pune

TOI-Article-Pune

Written by Surya Hospitals

21/10/2021



PUNE: A 36-week premature baby, diagnosed with severe immune overreaction linked to post-Covid syndrome, recovered successfully at a city hospital after experiencing a slew of complications, including renal failure necessitating dialysis, in June.

The baby’s mother had Covid-19 infection at 14 weeks of pregnancy which, the experts said, might have led to the transmission of the infection to the fetus through the placenta. The baby was born on May 22, following which both the baby and the mother were detected with high concentration of SARS-CoV-2 antibodies.

The baby’s condition started worsening rapidly five days after the birth. The newborn went on to develop respiratory failure, shock due to a steep drop in blood pressure, kidney failure, which necessitated life-saving ventilator support. On the brighter side, treatment with fast-acting antibodies, called intravenous immunoglobulins, and steroids with early initiation of peritoneal dialysis dramatically improved the baby’s condition.

The baby registered full recovery on all parameters and was discharged after 16 days of intensive care at the hospital on June 16. “This is the first case of a preterm neonate in medical literature to survive multisystem inflammatory syndrome in neonates (MIS-N) despite acute kidney injury (AKI) requiring dialysis in India,” said chief neonatologist Dr. Sachin Shah of Surya Mother and Child Superspeciality Hospital in Wakad.

The severe AKI was the main presenting complaint and needed peritoneal dialysis as opposed to cardiovascular involvement in previously reported cases of MIS-N. Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can’t adequately do the job any longer. As per reported worldwide literature, there are just 22 cases with variable presentations of MIS-N, mortality in which is above 10%.

“The progression of AKI in children is considered a post-viral inflammatory response. It is not clearly understood at this time. The general consensus is that there is a cytokine storm (abnormal immune overreaction) leading to organ damage,” Shah said.

Some of the blood tests of the baby, including D dimer, were elevated indicating a hyperimmune response. “Though in the majority of newborns, the antibodies are protective, in some cases, they may trigger an abnormal inflammatory response and cytokine storm leading to rapid deterioration of the clinical condition,” he said.

The take-home message is clear. “A typical presentation of MIS-N in the form of AKI should not be missed since it is treatable with definitive and supportive care,” Dr. Shah said.

“The child is doing fine and attaining all the developmental milestones,” said the mother of the child. Other members of the hospital team who took care of the baby at various stages of complications included neonatal intensivists Dr. Amita Kaul, Dr. Ganesh Shiwarkar, Dr. Saleha Dhalait and nephrologist Dr. Girish Kumthekar.




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