Acute Dengue fever in a Neonate Secondary to Perinatal Transmission

Dengue in pregnancy is associated with adverse maternal and fetal outcomes including perinatal transmission. We report a case of neonatal dengue in a baby born to a 29-year-old primigravida at 38 weeks gestation. She developed acute dengue fever two days prior to delivery. Her dengue NS 1 antigen was reactive. She delivered a term baby girl via spontaneous vaginal delivery.. Her fever persisted in the post-partum period; which was associated with post-partum hemorrhage, altered coagulation and liver function. She was clinically diagnosed to have HLH (Hemophagocytic lymphohistiocytosis), complicated with DIC (Disseminated Intravascular Coagulation); hence treated with IV dexamethasone, multiple blood products including FFP and platelet concentrate. She recovered in over the next 5 days. The baby girl was born with birth weight of 3040 grams, developed fever on day three of life with poor perfusion, associated with mottling and hypotension. Baby was treated with iv fluids, inotropes and supportive care. The fever subsided after 48 hours along with clinical improvement but continued to have thrombocytopenia. Baby did not have any bleeding. Platelet recovery started on 11th postnatal day (8th day of illness) and platelet count normalized at 2 weeks. Dengue serology IgM by ELISA was positive in both mother and baby. The clinical diagnosis was confirmed by laboratory tests. Dengue fever in mother very late in pregnancy can cause symptomatic dengue infection in the neonate.