Newborn beats Covid-MIS, erratic heartbeat

BENGALURU: A newborn baby boy from Peenya, who not only suffered from post-Covid multi-system inflammation but also an abnormally erratic heartbeat, has survived. Doctors who treated him claim this is the first such case to be reported in India and only the second in the world.

This means they had very little precedent to go by which made their task immensely challenging. The case is being presented in an international journal.

The baby’s condition was diagnosed as supraventricular tachycardia (SVT), where the heart beats per minute exceeded 250 as against the normal 120-180 per minute. The life-threatening condition would repeat every two hours after briefly stabilizing due to medical intervention.

The baby was born of a normal delivery and was of normal weight but began developing breathing difficulties when he was 11 days old. He was taken to a private hospital where he was diagnosed with myocarditis or inflammation of the heart muscle. This affected the heart’s electrical system and its ability to pump, thereby causing rapid or abnormal heart rhythms.

On further examination it was revealed that the baby’s heart condition was an after-effect of post Covid MIS-C (multi-inflammatory syndrome in children). Since his condition began to deteriorate, he was referred to Narayana Health City on June 27, when he was just two weeks old. He was transported in an ambulance equipped with a neonatal ICU, ventilator support and a specialised medical team.

Too ill when referred

As the baby’s critical organs were affected, the hospital decided to follow a multi-disciplinary approach involving neonatologists Dr Harini S and Dr Rajiv Aggarwal, paediatric cardiologists, Dr Deepika T and Dr Prakash R and paediatric rheumatologist Dr Aruna Bhat. “The baby was too ill when referred to us and the hospital from where he was sent was worried that he may not even survive the journey,” said Dr Harini.

MIS affected multiple organs, and, in this case, it led to the heart beating at an abnormally high rate. “But interestingly, after treatment and stabilisation, the heartbeat would reduce only to increase again. The baby suffered from an abnormal heart rhythm once every two hours,” doctors said.

On ventilator support

The baby had to be on ventilator for a prolonged time. “He had to be treated to maintain blood pressure as his heart was compromised,” said Dr Harini. Although SVT is not unknown among newborns, this is the first time it was a post-Covid risk, she added.

Doctors also had to keep changing the medication since the first and second line of treatment didn’t work. Also, the drugs used were not those routinely used for newborns. The medical team was prepared to treat side effects, if any. Doctors had to take multiple ECGs in a day. A combination of three anti-arrhythmic drugs and intravenous immunoglobulin finally did the trick.

No symptoms

While the mother had no symptoms, both she and her baby showed the presence of Covid-19 antibodies when tested post-delivery.

Dr Aruna said children of all ages, including neonates, can present with various symptoms of MIS. Cardiac complications can often be challenging and will require prompt identification and treatment.

After prolonged ventilation, the baby was discharged on July 8. Back to normal breathing and feeding, the child is now one-anda-half months old.