title: Neonatal adenoviral infection: a seventeen year experience and review of the literature.
abstract: OBJECTIVE
  To describe the clinical manifestations and short-term outcomes of adenoviral infections in neonates and review all published cases to better determine impact and treatment outcomes.
  
  
  METHODS
  Retrospective cohort study of all neonates hospitalized at Children's Medical Center (CMC) and Parkland Memorial Hospital (PMH), Dallas, TX with laboratory-confirmed adenoviral infection from January 1,1995-December 31, 2012. Neonates were identified by review of the CMC Virology Laboratory's prospective database of all positive adenovirus tests performed in the inpatient and ambulatory settings, and at PMH, of a prospective neonatal database that included all neonatal intensive care unit admissions. Patients also were identified by discharge International Classification of Disease, 9th edition codes for adenoviral infection. The medical records were reviewed, and a review of the English literature was performed.
  
  
  RESULTS
  During 17 years, 26 neonates had adenoviral infection (25, CMC; 1, PMH). The principle reasons for hospitalization were respiratory signs (88%) and temperature instability (65%). Five (19%) had disseminated disease and 4 (80%) of these infants died. Ribavirin or cidofovir treatment, as well as immune globulin intravenous, did not improve outcomes except in 1 neonate. Literature review (n = 72) combined with our data found that disseminated infection was associated with death (68% vs 21% with localized infection, P < .001). In addition, neonates <14 days of age were more likely to have disseminated disease (44% vs 12%, P = .004) and death (48% vs 8%; P < .001).
  
  
  CONCLUSIONS
  Adenoviral infection in hospitalized neonates was associated with severe morbidity and mortality, especially when infection was disseminated and involved the respiratory tract. Development of new therapeutic strategies is needed.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ronchi
authors.affiliation: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX; Children's Medical Center, Dallas, TX.
authors.forename: Christopher
authors.initials: C
authors.lastname: Doern
authors.affiliation: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX; Children's Medical Center, Dallas, TX.
authors.forename: Evangeline
authors.initials: E
authors.lastname: Brock
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Pugni
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: pablo.sanchez@nationwidechildrens.org.
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
mesh_terms: D000256:Adenoviridae / Q000235:genetics; D000257:Adenoviridae Infections / Q000188:drug therapy / Q000453:epidemiology*; D000367:Age Factors; D000998:Antiviral Agents / Q000627:therapeutic use; D001831:Body Temperature; D000077404:Cidofovir; D015331:Cohort Studies; D003371:Cough / Q000821:virology; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003967:Diarrhea / Q000821:virology; D005221:Fatigue / Q000821:virology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000821:virology; D006529:Hepatomegaly / Q000821:virology; D006801:Humans; D007022:Hypotension / Q000821:virology; D000860:Hypoxia / Q000821:virology; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007508:Irritable Mood; D008297:Male; D009123:Muscle Hypotonia / Q000821:virology; D063065:Organophosphonates / Q000627:therapeutic use; D010198:Pancytopenia / Q000821:virology; D016133:Polymerase Chain Reaction; D012135:Respiratory Sounds; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D013163:Splenomegaly / Q000821:virology; D059246:Tachypnea / Q000821:virology; D014839:Vomiting / Q000821:virology
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D063065:Organophosphonates; D012254:Ribavirin; D003596:Cytosine; D000077404:Cidofovir