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Wednesday, June 16, 2021

Gujarat: MIS-C in newborns could be Covid antibody side-effect, say neonatologists

The indications of a weak cry, shock, and low heart pumping rate pointed towards a multisystem inflammatory syndrome in children (MIS-C), doctors said, and the condition appeared to be linked with Covid-19.

Written by Aditi Raja , Gopal Kateshiya, Sohini Ghosh | Ahmedabad, Rajkot, Vadodara |
May 16, 2021 4:50:02 am
Currently, treating two newborns at SSG for the syndrome, Aiyer said the hospital has seen at least 14 newborns with MIS-C and Covid-19 antibodies recently. (Pixabay)

On April 20, a newborn baby, born at 38 weeks gestation, was admitted to the neonatal unit of Akanksha Hospital and Research Institute (AHRI) in Anand within an hour of his birth with an “extremely diseased condition”. The indications of a weak cry, shock, and low heart pumping rate pointed towards a multisystem inflammatory syndrome in children (MIS-C), doctors said, and the condition appeared to be linked with Covid-19.

While RT-PCR and antibody tests on the baby found him negative for the novel coronavirus, doctors were surprised to find a high concentration of antibodies in the child. Earlier, an RT-PCR test on the mother had also found her negative for the virus.

Dr Biraj Thakkar, a neonatologist at AHRI, said while Covid-19 antibodies protect adults from the virus, they can impair the immune system in newborns and so, the baby had to be put on ventilator support and administered steroids.

“Newborns can get infected by Covid-19 in three ways — by contact with an infected caretaker after birth, a vertical transmission within the womb by the infected mother, while it can also be airborne. (In cases) where the RT-PCR is negative but antibodies are present, (possibilities are) the mother may have been infected during pregnancy and produced antibodies, which was passed onto the womb through the placenta,” Dr Thakkar told The Sunday Express.

In the current case, the family was unaware if the mother had contracted Covid-19 during her pregnancy and recovered. “She could have recovered without showing symptoms and they (the family) were not aware. But the presence of high-level antibodies in the baby meant that it was passed by the mother through the placenta and it is known to be harmful to babies in the case of Covid-19. Even the baby’s lungs were affected and we had put him on a high-frequency ventilator and administered steroids. A D-dimer test on the newborn revealed a level of 21,000 when normally infected babies test up to the value of 3,000,” Dr Thakkar said. A D-dimer is a blood test that can be used to help rule out the presence of a serious blood clot.

After 22 days of hospitalisation — nine days on ventilator support and about 12 days on oxygen support, the baby was discharged from NICU on May 13, the neonatologist said.

According to doctors, MIS-C has become common among children, including newborns, during the current wave of the pandemic. Dr Sheila Aiyer, the head of the department of paediatrics at SSG Hospital in Vadodara, said the current double-mutant strain of Covid-19 has thrown up several cases where newborns were found to be affected by MIS-C, of them several also test positive for Covid-19 antibodies.

Currently, treating two newborns at SSG for the syndrome, Aiyer said the hospital has seen at least 14 newborns with MIS-C and Covid-19 antibodies recently.

“We do not check antibodies in all newborns unless they are showing MIS-C. We are seeing it frequently now… We were not seeing neonatal Covid-19 in the first wave. Although the overall percentage of children and newborns affected is low as compared to adults, it is not an insignificant number. Paediatricians across the country are discussing the possibilities and are facing a dilemma of researching on these findings,”

At SSG hospital, which records a high number of deliveries every day, at least 14 newborns were found with MIS-C symptoms, of them 13 had (Covid-19) antibodies, the doctor said. “A couple of them did not survive. That could be because of overlaps with other neonatal comorbid conditions, like diabetics, anaemia, developmental challenges, and seizures. Now, we are trying to put the first four cases at SSG of newborns with antibodies as case studies.”

According to Aiyer, if the concentration of the antibodies in a newborn baby is higher than those in the mother, the indication is that the baby has self-produced the antibodies. “If the antibodies are passed on by the mother, the concentration of the baby’s antibodies will be lower than the mother but we have had a couple of cases where we have seen the newborn with higher concentration, which means that the babies have produced its own antibodies,” Dr Aiyer said.

AHRI’s Dr Thakkar said the effects of Covid-19 antibodies on newborns are “more visible” in the current wave because more expectant mothers were actually infected in the second half of 2020 and developed antibodies as compared to mothers who were expecting during the outbreak of the virus.

‘More research on MIS-C needed’

Dr Bhadresh Vyas, professor at paediatrics department in MP Shah Government Medical College, said more research on MIS-C was needed, but prima facie it appeared to be a post-Covid complication. “These cases seem to be post-Covid complications. These cases are being detected due to increased awareness among paediatricians about MIS-C. Previously, many people didn’t know about MIS-C and, therefore, reporting was not as good,” he said.

The institute, he said, has seen two-three cases of paediatric MIS-C. “While one did not survive, one is still undergoing treatment,” Dr Vyas added.

He added the phenomenon of infants with Covid-19 antibodies was yet to be studied. “Newborns delivered by mothers who are Covid-19 positive or has had exposure to the virus are surviving and generally all types of antibodies are gifted to babies by their mothers.”

At Ahmedabad Civil Hospital, which has recorded about 100 Covid-19 paediatric patients from March to April this year against 200 paediatric patients last year after the outbreak of the pandemic, Dr Charul Mehta, associate professor of the department of paediatrics and neonatologist at BJ Medical College, said conclusive research is necessary to ascertain the kinds of antibodies being seen in newborns.

“We have seen mortality in children with multiorgan failure, or those with comorbid conditions. While anecdotal reports have emerged of newborns detected with antibodies against Covid-19, it is difficult to conclude whether there has been antenatal or perinatal transmission of antibodies among newborns or whether antibodies developed in newborns owing to infection acquired. It has to be studied in a graded manner with a protocol designed for the same,” Dr Mehta said.

In a study to see if there is perinatal transmission of antibodies conducted last year, she added, the hospital found that it was not the case. Dr Mehta explains that while the IgM antibody is produced about a week or 10 days after the Covid-19 infection, IgG antibody develops around one or one-and-half months after the infection. “We need to study now that if indeed antibody is present in a newborn, what type is it. If it is IgG, then it could be possible that the newborn was transferred antibodies from the mother as it can cross the placenta,” Mehta said.

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