title: Distinctive pattern of white matter injury in neonates with rotavirus infection.
abstract: OBJECTIVE
  To report a consecutive series of neonates with seizures or apnea and displaying white matter injuries with distinctive magnetic resonance diffusion-weighted imaging (DWI) pattern, and to discuss the high positive rate of rotavirus infection seen in these patients.
  
  
  METHODS
  In a retrospective review of neonates who were admitted to a tertiary referral center with seizures or apnea, we found a distinctive pattern of white matter injury (symmetrical restricted diffusion in the periventricular white matter and white matter tracts including the corpus callosum) in 18 patients. We describe the clinical and laboratory features of these 18 neonates. Additional PCR analyses for rotaviruses and parechoviruses were performed on banked frozen samples of CSF of 4 patients and blood of 15 patients.
  
  
  RESULTS
  All 18 patients were born at term and healthy until symptoms occurred 4-7 days after birth. No history of asphyxia was observed. Only 1 patient presented with fever, and no patient showed a rash. All patients except 1 (94.4%) were rotavirus-positive in stool samples. However, neither rotaviruses nor enteroviruses/parechoviruses were detected in the CSF and blood. Tissue loss was observed in 5 of 8 subjects on repeat MRI scans.
  
  
  CONCLUSIONS
  Neonates with this distinctive DWI pattern had a high positive rate of rotavirus infection, without evidence of other pathogens, and were characterized as term newborns with neurologic symptoms arising approximately the fifth day after birth. Although the specificity of this pattern is unclear, rotavirus testing should be considered for neonates presenting with this DWI pattern.
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Jung Sook
authors.initials: JS
authors.lastname: Yeom
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Seo
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Ji Sook
authors.initials: JS
authors.lastname: Park
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Eun Sil
authors.initials: ES
authors.lastname: Park
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Jae-Young
authors.initials: JY
authors.lastname: Lim
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Hyang-Ok
authors.initials: HO
authors.lastname: Woo
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Hee-Shang
authors.initials: HS
authors.lastname: Youn
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Dae Seob
authors.initials: DS
authors.lastname: Choi
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Ju-Young
authors.initials: JY
authors.lastname: Chung
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Tae-Hee
authors.initials: TH
authors.lastname: Han
authors.affiliation: From the Department of Pediatrics (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science (J.S.Y., J.-H.S., J.S.P., E.S.P., J.-Y.L., H.-O.W., H.-S.Y., C.-H.P.), Jinju; Department of Neurology (Y.-S.K.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon; Department of Radiology (D.S.C.), Gyeongsang National University School of Medicine, Jinju; and the Departments of Pediatrics (J.-Y.C.) and Diagnostic Laboratory Medicine (T.-H.H.), Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea. aroma@gnu.ac.kr.
authors.forename: Chan-Hoo
authors.initials: CH
authors.lastname: Park
mesh_terms: D001049:Apnea / Q000209:etiology; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D056784:Leukoencephalopathies / Q000150:complications / Q000473:pathology*; D008297:Male; D012189:Retrospective Studies; D012400:Rotavirus Infections / Q000150:complications / Q000473:pathology*; D012640:Seizures / Q000209:etiology; D066127:White Matter / Q000473:pathology*