Table3_Multisystem inflammatory syndrome in neonates (MIS-N): an updated systematic review.docx

IntroductionThe aim of the study was to summarize and update clinical features and outcomes of multisystem inflammatory syndrome in neonates (MIS-N).
MethodsA systematic literature search was conducted of studies on MIS-N published in PubMed, MEDLINE, EMBASE, CNKI, and WHO COVID-19 databases between 1 December 2019 and 30 June 2023. Reference lists of selected articles, Google Scholar, and pre-print servers were searched for additional studies. The methodological quality of included studies was assessed.
ResultsOf 1,572 records screened after the initial search, 35 studies involving a total of 201 neonates with MIS-N were included. One study was retrieved from a pre-print server. For those with available data, 34/47 (78.7%) mothers were infected in the third trimester. Of the 199 mothers (two with twin pregnancies), 183 (92.0%) were from India. The median age of neonates at presentation was 2.0 days (interquartile range 1.0–9.5). Over two-thirds (144/201, 71.6%) presented with respiratory distress, while 112 (55.7%) had cardiac involvement, such as ventricular dysfunctions, involvement of coronary arteries, and atrioventricular blocks. Arrhythmias and thrombosis were reported in 15/201 (7.5%) and 2/201 (3.0%) neonates, respectively. All neonates, except one, required critical care; 64/160 (40.0%) required inotropic support and 105/187 (56.1%) required respiratory support, of whom 59/105 (56.2%) were specified to require intubation. The mortality rate was 5.0% (10/201).
Discussion/ConclusionMIS-N should be considered in ill neonates presenting with involvement of two or more organ systems, especially among those neonates with cardiorespiratory dysfunctions, in the presence of proven or suspected maternal COVID-19 infection during pregnancy.
Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278717, PROSPERO, identifier CRD42021278717.

引言
本研究旨在总结并更新新生儿多系统炎症综合征（multisystem inflammatory syndrome in neonates, MIS-N）的临床特征与转归情况。

方法
本研究于2019年12月1日至2023年6月30日期间，针对PubMed、MEDLINE、EMBASE、CNKI及WHO COVID-19数据库中已发表的新生儿多系统炎症综合征相关研究开展系统性文献检索。同时通过检索纳入文献的参考文献列表、Google Scholar及预印本服务器以补充获取相关研究。此外，对纳入研究的方法学质量进行了评估。

结果
初始检索共筛选出1572条记录，最终纳入35项研究，涉及201例新生儿多系统炎症综合征患儿。其中1项研究来自预印本服务器。在数据可及的病例中，47例母亲中有34例（78.7%）在妊娠晚期发生感染。199位母亲（其中2位为双胎妊娠）中，183位（92.0%）来自印度。患儿就诊时的中位年龄为2.0天（四分位间距1.0~9.5天）。超过三分之二的患儿（144/201，71.6%）以呼吸窘迫为首发表现，112例（55.7%）存在心脏受累，包括心室功能异常、冠状动脉受累及房室传导阻滞。分别有15例（7.5%）和2例（3.0%）患儿出现心律失常与血栓形成。除1例外，所有患儿均需接受重症监护；64/160（40.0%）患儿需要正性肌力支持，105/187（56.1%）需要呼吸支持，其中59/105（56.2%）明确需行气管插管。总体病死率为5.0%（10/201）。

讨论与结论
对于出现多器官系统受累的重症新生儿，尤其是合并心肺功能异常的患儿，若母亲在妊娠期间存在确诊或疑似COVID-19感染，应考虑新生儿多系统炎症综合征的可能。

系统评价注册
系统评价注册于PROSPERO平台，注册号为CRD42021278717，注册链接：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278717