Lyme Disease in a Newborn: A Mother’s Experience

Q: Can a Lyme disease test be negative in a newborn?

Yes. Antibody testing can be negative during early localized Lyme disease because the immune system may not yet have produced detectable antibodies.

Newborn became unusually sleepy after a tick bite
A red rash developed without a classic bull’s-eye appearance
Hospitalization and intravenous treatment followed

The mother discovered a tick on her newborn daughter. “Three days later, she was very sleepy and hard to rouse,” she wrote in CMAJ.

Although Lyme disease is uncommon in newborns and young infants, it can develop after the bite of an infected tick. This case illustrates both the medical concerns and the practical challenges one family encountered obtaining hospital and home infusion care.

Important: A newborn who is difficult to awaken, has a fever, feeds poorly, develops an unexplained rash, or appears seriously ill requires immediate pediatric medical evaluation. These symptoms are not specific to Lyme disease and may indicate another urgent condition.

Lyme Disease After a Tick Bite in a Newborn

The infant was 21 days old when she was admitted to the hospital with decreased activity, poor feeding, and abdominal distension. Her parents had removed an engorged tick from her forearm five days earlier.

An erythematous patch with partial central clearing developed at the site of the tick bite. Although it did not have the familiar bull’s-eye appearance, clinicians considered it an erythema migrans rash and made a presumptive diagnosis of Lyme disease.

This is an important reminder that a Lyme disease rash does not always resemble a perfectly formed bull’s-eye.

The newborn was hospitalized and treated with intravenous ceftriaxone. She subsequently completed a 14-day course of treatment administered through a PICC [peripherally inserted central catheter] line.

Her Lyme antibody test was nonreactive. However, antibody testing may be negative during early localized Lyme disease, and the treating clinicians based the presumptive diagnosis on the tick exposure and erythema migrans lesion.

Challenges Obtaining Care for a Newborn With Lyme Disease

The mother described sleeping in a small hospital bed next to her child. The situation was made more difficult by COVID-19 restrictions. She felt isolated, experienced depression and anxiety, and remained concerned about her 3-year-old child at home.

Travel also presented a major obstacle. The mother did not believe she could manage a three-hour round trip while caring for her newborn.

“They were trying to transfer us to a closer hospital, but one local hospital wouldn’t take her because of the PICC line and the other didn’t have beds. And there was a real shortage of home care nurses,” she wrote.

Fortunately, the mother was a specialized infusion and injection nurse. Although she was reluctant to assume this responsibility for her own newborn, she was able to care for the PICC line and administer the infusions at home.

The Emotional Impact on the Family

The mother described herself as having “tick PTSD [posttraumatic stress disorder]. We have 55 acres of hay field surrounding us and it has definitely changed the way we play outside.”

The emotional impact of a serious illness in a newborn can extend beyond the patient and affect the entire family. Living in an area with frequent tick exposure may also change how parents approach outdoor activities.

Editor’s note: This family’s difficulties obtaining care were compounded by the COVID-19 pandemic. Nevertheless, I have encountered families who struggled to find timely evaluation and treatment for pediatric Lyme disease even outside the pandemic.

The Newborn Recovered After Treatment

The erythema migrans rash resolved after two days of ceftriaxone. At follow-up, when the infant was eight weeks old, she had no symptoms attributed to Lyme disease and was demonstrating normal growth and development.

The accompanying clinical report also described a possible Jarisch–Herxheimer reaction shortly after treatment began. Because fever and clinical deterioration in a newborn may have several serious causes, the medical team evaluated the infant for neonatal sepsis and other possible explanations.

Frequently Asked Questions

Can babies get Lyme disease?

Yes. Although uncommon in newborns and young infants, Lyme disease can develop after the bite of an infected tick.

What symptoms may raise concern after a tick bite in a newborn?

In this case, the newborn developed unusual sleepiness, decreased activity, poor feeding, abdominal distension, and a red rash. Fever, difficulty awakening, poor feeding, or any other sign of illness in a newborn requires immediate pediatric evaluation. These symptoms are not specific to Lyme disease.

Can a newborn get Lyme disease from a tick bite?

Yes. The published case describes probable Lyme disease in a newborn after an engorged tick was removed from the infant’s forearm.

Does every baby with Lyme disease develop a bull’s-eye rash?

No. An erythema migrans rash may be uniformly red, have partial central clearing, or appear differently from the familiar bull’s-eye pattern. Some patients do not notice a rash.

Can a Lyme disease test be negative in a newborn?

Yes. The antibody test in this case was nonreactive. Antibody testing can be negative during early localized Lyme disease because the immune system may not yet have produced detectable antibodies.

Clinical Takeaway

Lyme disease following a tick bite is uncommon in a newborn, but this published case demonstrates that it can occur. The infant developed an erythema migrans lesion and became unusually sleepy, less active, and difficult to awaken.

Any newborn who develops unusual sleepiness, fever, poor feeding, an unexplained rash, or other signs of illness should receive immediate pediatric evaluation. Clinicians should consider the complete clinical picture, including possible tick exposure, while also evaluating other potentially serious causes.

Lyme disease and Herxheimer reaction in a newborn

Congenital transmission of Babesia diagnosed in a 5-week-old twin

Tick bites during pregnancy: A clinical perspective

Warning signs after a tick bite