Neonatal Dengue- A Case Series

Abstract

Dengue is one of the commonest arboviral infections seen in children but in neonates, it is a disregarded entity. It can be acquired either through vertical (transplacental) or horizontal transmission (mosquito bite). It usually presents with fever, lethargy, poor feeding, and thrombocytopenia which can be accompanied by hepatosplenomegaly, transaminitis, fluid leak, petechiae, bleeding, Acute Respiratory Distress Syndrome (ARDS), shock and Acute Kidney Injury (AKI). Dengue shock in neonates responds well to dopamine if used early. A retrospective review of case records of five neonates admitted with dengue fever from October 2021 to October 2022 showed the neonates average age was 10 days and male:female ratio of 3:2. Three cases had horizontal and two cases had vertical transmission. All neonates presented with fever and were admitted within one week of illness. Petechial rashes and refusal of feeds were observed in two cases. Four cases had leukopenia whereas, all cases had thrombocytopenia. Sepsis was ruled out. Dengue Nonstructural protein 1 (NS1) antigen was positive in four cases. IgM antibody was positive in all while IgG was negative in all cases. None of the cases had hepatic derangement except for mild transaminitis in three cases. Only two cases had severe thrombocytopenia requiring platelet transfusion, but none developed bleeding, plasma leakage, shock requiring inotropes or fluid overload. Mortality due to neonatal dengue was nil and the duration of hospital stay ranged between 6-12 days. In the vertically transmitted cases, isolation of the virus from the breast milk or cord blood was not done due to logistics. Therefore, dengue fever can be suspected as one of the differentials in any neonate presenting with fever, leukopenia, and thrombocytopenia mimicking sepsis, especially during the epidemic season.