Navigating the diagnostic dilemma of neonatal dengue syndrome: a review and report.

Background: There are currently no specific guidelines for neonatal dengue. The available guidelines focus on the pediatric age group. The objective of this study is to summarize the clinical presentations and management strategies, based on the available studies in literature and to report another case of neonatal dengue.

Methods: The PUBMED and Scopus databases were searched using "neonate", "dengue", and their synonyms as the search terms. We included observational studies of suspected or proven cases of neonates with dengue infection, irrespective of their gestational age and birth weight. The studies were screened for possible inclusion in the review by two independent reviewers. The neonates that died in hospital among the reported cases were compared with those that survived till discharge, for reported baseline variables, using chi-square/fisher's exact test, Wilcoxon-Rank Sum test, and multivariable logistic regression.

Results: A total of 57 observational studies on neonatal dengue were found. Of these, 41 were case reports of single cases, 15 were case series of 2 or more cases and 1 was a cohort study. These included a total of 144 cases apart from our reported case. The most common clinical manifestations were thrombocytopenia (81.69%), fever (61.97%), rash (45.07%), and organomegaly (29.58%). Supportive care with fluids and platelet transfusion for severe thrombocytopenia were the mainstay of therapy. Most neonates (94.4%), improved after a week of onset of symptoms with median and interquartile range (IQR) of 7 (6-10) days. Only 8 neonatal dengue deaths were reported in the available literature. When compared with those who survived till discharge, except for third spacing (p-value = 0.001), none of the other baseline clinical parameters were found to be significantly different. On multivariable logistic regression analysis, for those factors with p-value < 0.2 in univariate analysis, none of the factors had an independent association with the outcome of death in neonatal dengue cases. Our index case also presented with high-grade fever on day 5 of life, petechial rash and thrombocytopenia on day 6 of life and improved by day 7 of illness with supportive care.

Conclusions: Neonatal dengue has a good prognosis as per the cases reported in the literature. None of the clinical parameters were found to be independently associated with neonatal mortality in the reported cases of neonatal dengue in literature. Further prospective observational studies will be needed to find the true predictors of poor outcomes in neonates with dengue infection.