Neonatal enterovirus infections: emphasis on risk factors of severe and fatal infections.
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.
Lin
Tzou-Yien
TY
Division of Pediatric Infecti=ious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
Kao
Hsiu-Tsun
HT
Hsieh
Shang-Hong
SH
Huang
Yhu-Chering
YC
Chiu
Cheng-Hsun
CH
Chou
Yi-Hong
YH
Yang
Peng-Hong
PH
Lin
Rey-In
RI
Tsao
Kuo-Chien
KC
Hsu
Kuang-Hung
KH
Chang
Luan-Yin
LY
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*
D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous