title: Neonatal enterovirus infections: emphasis on risk factors of severe and fatal infections.
abstract: OBJECTIVE
  Neonatal enterovirus infections have diverse manifestations, from asymptomatic to fatal. An understanding of the risk factors associated with severe cases might help to reduce enterovirus-related morbidity and mortality.
  
  
  METHODS
  From July 1989 through June 1998, neonates with virus culture-confirmed nonpolio enterovirus infection at Chang Gung Children's Hospital were enrolled in the study and divided into three groups: nonspecific febrile illness; aseptic meningitis; and hepatic necrosis with coagulopathy (HNC). Demographic factors, clinical manifestations, laboratory data and outcome were analyzed to reveal factors associated with clinical severity and fatality.
  
  
  RESULTS
  There were 146 cases including 43 neonates with nonspecific febrile illness, 61 with aseptic meningitis and 42 with HNC. By multiple logistic regression analysis, the most significant factors associated with HNC were prematurity, maternal history of illness, earlier age of onset (< or =7 days), higher white blood cell count (WBC > or =15 000/mm3) and lower hemoglobin (< or =10.7 g/dl). In 10 (24%) of 42 cases, HNC was fatal. In comparison with nonfatal cases of HNC, fatal cases had higher WBC, lower hemoglobin, higher bilirubin and higher incidence of concurrent myocarditis. Multivariate analysis showed the most significant factors associated with fatality from HNC to be total bilirubin >14.3 mg/dl (adjusted odds ratio, 29.1; 95% confidence interval, 2.5 to 355.5; P = 0.007) and concurrent myocarditis (adjusted odds ratio, 13.7; 95% confidence interval, 1.1 to 177.2; P = 0.04). Intravenous immunoglobulin did not correlate with clinical outcomes in cases with HNC.
  
  
  CONCLUSIONS
  Prematurity, maternal history of illness, earlier age of onset, higher WBC and lower hemoglobin are significant factors associated with HNC; higher total bilirubin and concurrent myocarditis were most significantly associated with fatality from HNC.
authors.affiliation: Division of Pediatric Infecti=ious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
authors.forename: Tzou-Yien
authors.initials: TY
authors.lastname: Lin
authors.forename: Hsiu-Tsun
authors.initials: HT
authors.lastname: Kao
authors.forename: Shang-Hong
authors.initials: SH
authors.lastname: Hsieh
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
authors.forename: Yi-Hong
authors.initials: YH
authors.lastname: Chou
authors.forename: Peng-Hong
authors.initials: PH
authors.lastname: Yang
authors.forename: Rey-In
authors.initials: RI
authors.lastname: Lin
authors.forename: Kuo-Chien
authors.initials: KC
authors.lastname: Tsao
authors.forename: Kuang-Hung
authors.initials: KH
authors.lastname: Hsu
authors.forename: Luan-Yin
authors.initials: LY
authors.lastname: Chang
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D002423:Cause of Death; D015331:Cohort Studies; D004770:Enterovirus / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D014766:Viremia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous