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Background Babesiosis is caused by Babesia microti and often transmitted via Ixodes scapularis. To the best of our knowledge, only 9 cases of vertical transmission have been reported. The spectrum of clinical presentation and optimal therapy for this population remains unknown. Methods Case 1 is a 4 week old female admitted with fever and irritability for 2 days. She was pancytopenic, with Hgb of 9.2 g/dL, Plt of 57 K/mm3, and absolute neutrophil count (ANC) of 500/mm3. Thin smear revealed 2.5% parasitemia. Mother was diagnosed with acute Lyme disease in the seventh month of pregnancy. Maternal serologies were positive for B. microti (IgM 1:100 and IgG &gt;1:320). The infant received 1 PRBC transfusion and was treated with 10 days of atovoquone and azithromycin. Case 2 is a 5 week old female twin A admitted with 2 days of pallor, fatigue and poor feeding. Initial Hgb was 3.4 Gm/dL. Peripheral blood smear revealed many intraerythrocytic parasites consistent with B. microti. Thin smear obtained 24 hours after initiation of therapy showed 2% parasitemia. During hospitalization, the patient developed neutropenia with ANC nadir of 800/mm3. The patient required 4 PRBC transfusions and was treated with azithromycin and atovoquone for 10 days. The mother had an acute, self-limited febrile illness at 23 weeks gestation. At infant’s presentation, maternal serologies revealed negative B. microti IgM and positive IgG (1:160). Placental tissue from both twins was positive for B. microti DNA by PCR. Twin B was asymptomatic, had negative B. microti blood PCR, a negative B. microti IgM, positive IgG of 1:30 felt to represent transplacental maternal antibody, and did not require treatment. Results Both infants were successfully treated without relapse. Conclusion Congenital babesiosis is rare and may cause profound hematologic disturbances. We report 2 cases exhibiting neutropenia in addition to anemia and thrombocytopenia, supporting recent assertions by Wormser et al. that this is a common finding. In addition, Case 2 presented with a severe hemolytic anemia significantly worse than previously reported. Finally, we demonstrated successful treatment in neonates without exchange transfusion, even with severe anemia. Disclosures All authors: No reported disclosures.

2589. Two Cases of Congenital Babesiosis