Multisystem inflammatory syndrome in a neonate secondary to COVID-19: a case report.

Introduction and importance: Multisystem inflammatory syndrome in children secondary to coronavirus disease 2019 (COVID-19) (MIS-C) is very common and may present with clinical features similar to Kawasaki disease but is rarely reported in neonates (MIS-N). Any history of maternal upper respiratory tract infection should raise suspicion of MIS-N secondary to COVID-19 in critically ill neonates. Case presentation: The authors present a term neonate with gradually progressive respiratory distress requiring mechanical ventilation with marked improvement after starting immunoglobulin and steroids after blood investigations revealed high IgG COVID-19 antibody titers. Clinical findings and investigation: Admitted to the Neonatal Intensive Care Unit as he received bag and mask ventilation for 30 s following delivery, he was kept under oxygen via nasal prongs; but he still had nasal flaring, subcostal retraction, and tachypnea. All the blood investigations were within normal limits except for elevated C-reactive protein. Intervention and outcome: With no improvement despite oxygen via nasal prongs, he was kept under bubble continuous positive airway pressure with positive end-expiratory pressure of 5 cm of H Conclusion: Multisystem inflammatory syndrome in neonates is rare but should always be considered in neonates with multisystem involvement and a history of maternal upper respiratory tract infection after excluding all other causes.