Abstract:
Background Neonatal malaria is defined as the detection of asexual stages of Plasmodium species in the cord
blood within the first 28 days of life. It can be congenital or acquired through mosquito bites or blood transfusions.
Neonates are generally considered to be relatively protected due to the multiple innate and acquired physiological
protective effects present in neonates. However, in areas where malaria is endemic, the prevalence of malaria in neo-
nates is high. The predominant clinical feature of malaria in neonates is fever. Other clinical manifestations of neonatal
malaria include respiratory distress, pallor and anaemia, hepatomegaly, refusal to feed, jaundice and diarrhoea. Atypi-
cal presentations without fever can lead to inaccurate diagnosis and contribute to neonatal morbidity and mortality.
Neonates from endemic areas with any of the above symptoms should be screened for malaria.
Case presentation We present a series of three cases of neonatal Plasmodium falciparum malaria that presented
atypically without febrile episodes and were diagnosed and managed at Mizan-Tepi University Teaching Hospital
between July and September 2023. The first patient presented with vomiting, refusal to feed, pallor, severe anaemia,
and splenomegaly. The second patient presented with an inconsolable cry, failure to pass feces, abdominal distention,
and anaemia. The third patient presented with vomiting and anaemia. All patients received a 7-day course of intrave-
nous artesunate; the first patient also received a blood transfusion. All patients recovered and were discharged.
Conclusions Partial immunity resulting from repeated malaria infections in endemic regions may result in the trans-
fer of high levels of maternal Immunoglobulin G (IgG) antibodies through the placenta and can produce different
atypical clinical presentations. In malaria-endemic areas, neonates presenting with any of the presenting signs
and symptoms of malaria, including afebrile presentation, require malaria screening to avoid delays in diagnosis
