To the Editor: A term female baby was born to a mother who had dengue hemorrhagic fever 9 d before delivery. The baby required resuscitation at birth. Baby was in compensated shock with prolonged bleeding time. Investigations showed a platelet count of 37,000/mm3, asparatate aminotransferase (AST)- 17,390 U/L, alanine transaminase (ALT)- 3051 U/L, prothrombin time (PT)- 60 s, international normalised ratio (INR) >5, activated partial thromboplastin time (APTT) >60 s. Chest radiograph showed white out lungs. Ultrasound of the lung showed bilateral pleural effusion with an alveolar interstitial pattern. Functional echocardiography showed a distended IVC with normal cardiac function. Ultrasound of the abdomen showed ascites with gallbladder wall edema. The NS-1 antigen and IgM antibody came positive for the baby on day 1 of life. Management included surfactant therapy, inotropic support, Vitamin K, platelet, fresh frozen plasma (FFP) transfusions, as there was clinical bleeding.

The presentation of congenital dengue is summarised in a systematic review by Pouliot et al. [1]. The average time between maternal fever and neonatal symptoms was 7 d (range 5–13 d) [2]. A pregnant female can pass the dengue virus to the fetus if she develops fever from 10 d before delivery to 10 h after delivery [3]. Immunoglobulin M can be detected as early as 4 d after the onset of illness [4]. NS1 positivity in the baby indicates the passage of the virus from mother to baby in utero. The viremia phase usually lasts for around 7 d. As the mother had dengue fever 9 d prior to delivery, dengue virus was transplacentally transferred to the fetus, and the fetus has mounted an antibody response in the form of IgM. In our case, placenta or cord sample was not tested, which could have been ideal for proving vertical transmission. Our newborn had capillary leak, distributive shock, thrombocytopenia, and acute liver failure from birth, which cannot be explained by any other illness other than congenital dengue.