Roy Shambhawi, Jha Vijendra N, Ranjan Binay
Department of Pediatrics, Jyoti Punj Hospital, Boring Road, Patna, Bihar, India.
Department of Psychiatry, DMCH, Laheriasarai, Bihar, India.
J Family Med Prim Care. 2022 Nov;11(11):7483-7490. doi: 10.4103/jfmpc.jfmpc_1284_22. Epub 2022 Dec 16.
Paediatric multi-system inflammatory syndrome in the form of multi-system inflammatory syndrome in children (MIS-C) and neonatal multisystem inflammatory syndrome (MIS-N) are being reported all over the world. While MIS-C is seen few weeks after active severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection in the same child, MIS-N is proposed to be occurring in neonates after active SARS-CoV-2 infection in the mother in antenatal period and hyperimmune response to the transplacentally transferred maternal IgG antibodies specific to SARS-CoV-2. Most of the cases which develop MIS-N present with cardiac findings in the form of rhythm disturbances. In this article, we report data, clinical presentation and management of 15 preterm and growth-restricted term neonates who presented with bleeding in the first 2 days of life. The coagulopathy could not be explained by the common causes of bleeding in this population and was refractory to the general line of management. Laboratory results had signs of hyperimmune response (raised procalcitonin [PCT], C-reactive protein [CRP]) and remarkably deranged coagulation profile (very high d-dimer levels with normal platelet counts and normal-to-high fibrinogen values). Most of the mothers had history of symptomatic COVID-19 infection in the antenatal period, and although all (including neonates) were negative by real-time polymerase chain reaction for SARS-CoV-2, serological testing showed positivity for IgG fraction of antibodies specific to SARS-CoV-2, but negative for IgM antibodies. This observation was similar to the phenomenon of MIS-N; however in our study, the hyperinflammatory response primarily affected the coagulation system. Although COVID-19 coagulopathy has been described in adults, it has been reported in the presence of severe active SARS-CoV-2 infection, unlike a delay of several weeks seen in our study. Hence, the term 'Neonatal post-COVID-19 coagulopathy' as proposed in this article needs further research and validation.
儿童多系统炎症综合征（MIS-C）形式的儿科多系统炎症综合征和新生儿多系统炎症综合征（MIS-N）正在世界各地被报道。虽然MIS-C在同一儿童感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后几周出现，但MIS-N被认为是在母亲孕期感染活跃的SARS-CoV-2后，新生儿对经胎盘转移的针对SARS-CoV-2的母体IgG抗体产生超免疫反应而发生的。大多数发生MIS-N的病例表现为心律失常形式的心脏症状。在本文中，我们报告了15例早产和生长受限足月儿在出生后前两天出现出血的病例的数据、临床表现和治疗情况。该凝血病无法用该人群出血的常见原因来解释，并且对一般治疗方法无效。实验室结果有超免疫反应的迹象（降钙素原[PCT]、C反应蛋白[CRP]升高）和明显紊乱的凝血指标（D-二聚体水平非常高，血小板计数正常，纤维蛋白原值正常至高值）。大多数母亲在孕期有症状性COVID-19感染史，尽管所有（包括新生儿）实时聚合酶链反应检测SARS-CoV-2均为阴性，但血清学检测显示针对SARS-CoV-2的抗体IgG部分呈阳性，但IgM抗体为阴性。这一观察结果与MIS-N现象相似；然而在我们的研究中，过度炎症反应主要影响凝血系统。虽然成人中已描述了COVID-19凝血病，但它是在严重活跃的SARS-CoV-2感染情况下被报道的，与我们研究中观察到的数周延迟不同。因此，本文提出的“新生儿COVID-19后凝血病”这一术语需要进一步研究和验证。
