Mumbai: Expectant mother? Mask up, especially in last trimester!

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Newborns of women who contracted the Omicron variant of COVID-19 in the last three months of pregnancy face the threat of MIS-N (multisystem inflammatory syndrome in neonates). In the past nine months, 15 newborns succumbed to MIS-N in Vadodara, Gujarat, claim gynaecologists and paediatricians who are treating a newborn who is on high-flow ventilator support, as his lungs have been damaged.

Doctors have advised all expectant parents to wear N95 masks, as the only path through which the virus can reach the foetus is the mother. Even if the pregnancy is at full-term stage, the foetus can develop lung complications, doctors said. Immunologist Dr Jacob John of Vellore said such cases should be brought to the attention of the Indian Council of Medical Research and National Institute of Virology, whose experts must ascertain the reason behind the lung infections.

Dr Rajesh Parikh, an obstetrician and gynaecologist who runs the Madhuvan Maternity and Eye Hospital in Vadodara, said, "Four newborns from my maternity home were diagnosed with COVID-related MIS-N and three have succumbed. The fourth, a three-kg baby who was delivered full-term with no problems at the time of birth, suddenly showed persistent grunting and had to be shifted to the neonatal ICU." A tweet by Dr Parikh on the newborn's condition in late September has gone viral on social media and is also being discussed by medical experts.

The tweet by Dr Rajesh Parikh, which went viral

"The infant has been shifted to a bigger setup, Kashiben Gordhandas Patel Children Hospital, where he is in the able hands of well-known paediatrician Dr Jainish Bhandari," said Dr Parikh. According to the doctor, the baby's parents had taken both doses of the vaccine and had no history of COVID-19. "The parents are in shock, as the child was born healthy and is suddenly fighting for his life. The prognosis is grim. MIS-N is a war we seem to be losing despite our best efforts. MIS-C (Multisystem Inflammatory Syndrome in Children) is not as terrible in outcome as MIS-N."

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He added that most MIS-N cases had some symptoms in common. "There are no signs of infection. All blood work for the septic screen turned out negative. All had a very high antibody titer. There were no active symptoms in the mother. Uneventful peripartum phase and delivery occurred," he said. Appealing to all pregnant women to take care, the doctor said, "Omicron is dangerous for neonates. Couples should wear masks the same way they refrain from drinking alcohol from the time they learn about the pregnancy."

Infant still putting up a fight

Dr Bhandari said, "Usually, we see MIS-N cases where the newborn's condition suddenly deteriorates and they succumb to the disease within 24 to 36 hours of admission in the neonatal ICU. In this case, the infant is fighting every moment and we all are hoping for a positive outcome." "While infants with MIS-N are mainly presenting with respiratory distress mostly at birth, older children are presenting with cardiac complications," he added. He stated that a lot of aspects of long-term COVID remain a mystery. "The only way to protect oneself right now is by wearing a mask and social distancing," he added.

What is MIS-N?

Dr Bhandari said when a mother contracts the virus, her body produces antibodies, which reach the baby via the placenta. "As the antibodies don't find any COVID antigen to destroy, they end up harming the foetus's lung tissue. So newborns who are genetically susceptible to developing multisystemic inflammatory disorders don't have lungs that can maintain oxygenation of the body once the placenta is cut after delivery. And hence pregnant women must take utmost care and mask up. The mother might not get anything more than mild symptoms, but the child can end up with serious complications. This is a relatively new disease we understand little about. Don't take it lightly," he said.

Expert view

Dr Jacob said, "We must collect as much information as possible before we come to any conclusion." He added, "The Omicron variant doesn't affect the lungs directly. We must also understand the antibody normal globulin, a protein, which by itself cannot damage tissue and we, therefore, cannot jump to conclusions."

15
Estimated no of newborns who succumbed to MIS-N in Baroda in nine months