title: Clinical manifestations of a cluster of rotavirus infection in young infants hospitalized in neonatal care units.
abstract: OBJECTIVE
  To define the clinical manifestations of rotavirus (RV) infection in neonates and young infants hospitalized in neonatal care units, which are rarely reported.
  
  
  METHODS
  From October 2008 to September 2010, a total of 153 stool specimens positive for RV were detected from 100 neonates and young infants hospitalized in neonatal care units of our hospital. Four infants had two episodes of RV infection. Demographics and clinical presentations of these infants were collected and analyzed. The infants were further classified as having hospital-acquired (HA) or community-acquired (CA) RV infection.
  
  
  RESULTS
  Of the 104 episodes from 100 patients, 76 (73%) were classified as HA. Fifty-six infants were male. The mean age of onset was 2 days. The most common presentations were loose stool passages (52.9%), abdominal distension (51.9%), blood or mucus in stool (42.3%), and unstable vital signs (32.7%). Watery character in stool passage was identified in 13.5% of the infants and vomiting in 21.2%. A picture suggestive of necrotizing enterocolitis (NEC) was identified in 22 episodes (21.1%), and 12 of these were stage II or above. The average number of hospitalization days from the onset of HA-RV infection was 23 days. Compared with those in the CA group, the infants in the HA group had a significantly higher rate of blood or mucus in stools (52.6% vs. 14.3%, p < 0.01) and unstable vital signs (39.5% vs. 14.3%, p = 0.02), but a lower rate of watery diarrhea (9.2% vs. 28.6%, p = 0.04) and fever (13.8% vs. 42.9%, p < 0.01). Overall, there were five deaths, but all of these infants had major diseases.
  
  
  CONCLUSIONS
  Bloody, mucoid stools and unstable vital signs, instead of fever with watery diarrhea, are commonly seen in neonates and young infants with RV infection. A substantial proportion of these infants may present as NEC. Once introduced, RV appears to become a troublesome problem of HA infections in neonatal care settings.
authors.affiliation: Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan.
authors.forename: I-Chen
authors.initials: IC
authors.lastname: Tai
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.forename: Rey-In
authors.initials: RI
authors.lastname: Lien
authors.forename: Chung-Guei
authors.initials: CG
authors.lastname: Huang
authors.forename: Kuo-Chien
authors.initials: KC
authors.lastname: Tsao
authors.forename: Tzou-Yien
authors.initials: TY
authors.lastname: Lin
mesh_terms: D017714:Community-Acquired Infections / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D003428:Cross Infection / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D005243:Feces / Q000737:chemistry / Q000821:virology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D012401:Rotavirus / Q000302:isolation & purification* / Q000472:pathogenicity*; D012400:Rotavirus Infections / Q000453:epidemiology / Q000473:pathology* / Q000821:virology*