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Prognosis for neonates with enterovirus hepatitis and coagulopathy

ABZUG, MARK J. MD

Pediatric Infectious Disease Journal: August 2001 - Volume 20 - Issue 8 - pp 758-763
Original Studies

Background. Neonatal enterovirus hepatitis and coagulopathy (EHC) can be a severe, life-threatening infection. However, the case-fatality rate of EHC and the prognosis for survivors are not well-defined.

Methods. A search of a hospital medical records database and the investigator’s files for the period 1983 to 2000 was performed. Patients with onset of enterovirus-associated illness at age ≤30 days and either (1) aspartate aminotransferase or alanine aminotransferase >3 times the upper limit of normal or (2) platelet count <100 000 plus an abnormal coagulation profile were included.

Results. Sixteen cases were identified. Symptoms began at a mean of 3.8 days (range, 1 to 7 days). Frequent clinical and laboratory findings included jaundice, lethargy, anorexia, hepatomegaly, thrombocytopenia, clotting time prolongation, elevated transaminase and bilirubin values and decreased fibrinogen and albumin concentrations. Five patients had myocarditis and 4 had encephalitis. Hemorrhagic complications occurred in 10 (intracranial hemorrhage in 5). Five (31%) patients died. Features discriminating patients who died from survivors were concomitant myocarditis (5 of 5 vs. 0 of 11, P < 0.001), encephalitis (3 of 5 vs. 1 of 11, P = 0.06), prothrombin time >30 s (4 of 5 vs. 1 of 9, P = 0.02) and intracranial hemorrhage (4 of 5 vs. 1 of 8, P = 0.03). Follow-up of 6 survivors revealed normalization of liver function and platelet counts, satisfactory growth and absence of significant medical problems.

Conclusions. The case-fatality rate of 31% is evidence of the potentially devastating nature of EHC. Concomitant EHC and myocarditis are especially serious, but the prognosis for children who survive neonatal EHC is generally excellent.

From the University of Colorado School of Medicine and The Children’s Hospital, Denver, CO.

Accepted for publication March 6, 2001.

Address for reprints: Mark J. Abzug, M.D., Pediatric Infectious Diseases, Box B055, The Children’s Hospital, 1056 E. 19th Avenue, Denver, CO 80218. Fax 303-837-2707; E-mail abzug.mark@tchden.org.

© 2001 Lippincott Williams & Wilkins, Inc.