title: Pulmonary hemorrhage due to Coxsackievirus B infection-A call to raise suspicion of this important complication as an end-stage of enterovirus sepsis in preterm twin neonates.
abstract: Prematurity is an important risk factor for the fulminate form of neonatal enteroviral infection. Pulmonary hemorrhage is a morbid complication that should be anticipated and managed aggressively due to its fatal outcome.
  
  
  
  To emphasize the significance of pulmonary hemorrhage as a complication of severe enterovirus infection in preterm neonates.
  
  
  
  This report is a description of the clinical history, medical management and clinical outcomes of two pairs of preterm twin newborns (30 weeks and 36 weeks) with fulminant infection due to Coxsackievirus B (CBV) infection.
  
  
  
  Maternal fever was reported in both deliveries and it was a factor in the decision for urgent cesarean section of the 30-week twins. Three of the four infants failed to survive. Their clinical course involved multiple organ system failure complicated with profound disseminated intravascular coagulopathy and pulmonary hemorrhage. Pulmonary bleeding leading to hypovolemic shock and respiratory failure was the direct cause of death in two cases.
  
  
  
  This small series of preterm neonates with the diagnosis of CBV sepsis highlights the importance of correct diagnosis of maternal enterovirus infection in order to extend pregnancy and allow the fetus time to passively acquire protective antibodies. This report emphasizes the morbid complication of pulmonary hemorrhage as a result of enterovirus infection that should be anticipated and managed aggressively due to its potentially fatal outcome. Moreover, evaluation and observation of the asymptomatic twin is recommended in order to detect early signs of infection and deterioration in that sibling as well.
authors.affiliation: Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel(1); Department of Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Rotem
authors.initials: R
authors.lastname: Orbach
authors.affiliation: Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel(1).
authors.forename: Dror
authors.initials: D
authors.lastname: Mandel
authors.affiliation: Department of Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Lubetzky
authors.affiliation: Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel(1).
authors.forename: Amit
authors.initials: A
authors.lastname: Ovental
authors.affiliation: Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel(1).
authors.forename: Alon
authors.initials: A
authors.lastname: Haham
authors.affiliation: Department of Virology Unit of the Microbiology Laboratory, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Ora
authors.initials: O
authors.lastname: Halutz
authors.affiliation: Department of Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of the Pediatric Infectious Disease Unit, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Electronic address: galiag@post.tau.ac.il.
authors.forename: Galia
authors.initials: G
authors.lastname: Grisaru-Soen
mesh_terms: D003384:Coxsackievirus Infections / Q000150:complications*; D029822:Enterovirus B, Human / Q000302:isolation & purification*; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008171:Lung Diseases / Q000209:etiology* / Q000473:pathology*; D008297:Male; D018805:Sepsis / Q000150:complications*; D014427:Twins
keywords: Coxsackievirus B; Enterovirus infection; Preterm neonate; Twin