Background: Malaria is an important cause of death and illness in children
worldwide. Most cases of neonatal malaria are misdiagnosed because of lack of specific
symptoms and general lack of awareness. Nothing much is known in literature about the
hematological changes during malaria infection and outcome of disease in neonates. Neonatal
malaria is an underdiagnosed entity. So this hospital based observational study aims
to assess diagnostic features of neonatal malaria.
Methods: From August 2004 to August 2013, information of all slide positive for malaria
cases aged 0 to 28 days admitted to our pediatric hospital was collected and analysed.
Results: 28 slide positive cases of neonatal malaria were studied, four out of them were
congenital malaria. Fever (93%) was the most common symptom followed by pallor (72%)
and diarrhoea (50%). We also found respiratory distress in four (14%) cases. Apart from
anemia and atypical lymphocytosis, We also found thrombocytopenia and low hematocrit,
MCV and RBC count. Two cases with bleeding manifestations expired during course of
Discussion: Malaria in the first few months of life can simulate transplacentally or postnatally
acquired infection such as TORCH, syphilis, neonatal hepatitis and septicemia all
having an important symptom complex of fever jaundice, hepatosplenomegaly and anemia.
Although in our cases clinical presentation has been similar to septicemia but culture of
blood, CSF and urine were sterile. The dilemma of distinguishing neonatal malaria alone
versus neonatal sepsis or both existing does not seem to be easily resolved by the use of
clinical features alone. The laboratory diagnosis of parasitemia in neonates require special
attention in Giemsa staining as well as the technical skill involved in malaria microscopy
because parasite densities are low. So high degree of suspicion is needed to diagnose malaria
in newborns presenting with fever and anemia.