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Neonatal enterovirus infections: emphasis on risk factors of severe and fatal infections

LIN, TZOU-YIEN MD; KAO, HSIU-TSUN MD*; HSIEH, SHANG-HONG MD; HUANG, YHU-CHERING MD, PhD; CHIU, CHENG-HSUN MD, PhD; CHOU, YI-HONG MD; YANG, PENG-HONG MD; LIN, REY-IN MD; TSAO, KUO-CHIEN BS; HSU, KUANG-HUNG PhD; CHANG, LUAN-YIN MD, PhD†

Pediatric Infectious Disease Journal: October 2003 - Volume 22 - Issue 10 - pp 889-895
Original Studies

Objectives. Neonatal enterovirus infections have diverse manifestations, from asymptomatic to fatal. An understanding of the risk factors associated with severe cases might help to reduce enterovirus-related morbidity and mortality.

Methods. From July 1989 through June 1998, neonates with virus culture-confirmed nonpolio enterovirus infection at Chang Gung Children’s Hospital were enrolled in the study and divided into three groups: nonspecific febrile illness; aseptic meningitis; and hepatic necrosis with coagulopathy (HNC). Demographic factors, clinical manifestations, laboratory data and outcome were analyzed to reveal factors associated with clinical severity and fatality.

Results. There were 146 cases including 43 neonates with nonspecific febrile illness, 61 with aseptic meningitis and 42 with HNC. By multiple logistic regression analysis, the most significant factors associated with HNC were prematurity, maternal history of illness, earlier age of onset (≤7 days), higher white blood cell count (WBC ≥15 000/mm3) and lower hemoglobin (≤10.7 g/dl). In 10 (24%) of 42 cases, HNC was fatal. In comparison with nonfatal cases of HNC, fatal cases had higher WBC, lower hemoglobin, higher bilirubin and higher incidence of concurrent myocarditis. Multivariate analysis showed the most significant factors associated with fatality from HNC to be total bilirubin >14.3 mg/dl (adjusted odds ratio, 29.1; 95% confidence interval, 2.5 to 355.5; P = 0.007) and concurrent myocarditis (adjusted odds ratio, 13.7; 95% confidence interval, 1.1 to 177.2; P = 0.04). Intravenous immunoglobulin did not correlate with clinical outcomes in cases with HNC.

Conclusions. Prematurity, maternal history of illness, earlier age of onset, higher WBC and lower hemoglobin are significant factors associated with HNC; higher total bilirubin and concurrent myocarditis were most significantly associated with fatality from HNC.

From the Divisions of Pediatric Infectious Diseases (TYL, HTK, SHH, YCH, CHC, LYC) and Neonatology (YHC, PHY, RIL), Department of Pediatrics, Chang Gung Children’s Hospital, and the Department of Clinical Pathology, Chang Gung Memorial Hospital (KCT), and the Laboratory for Epidemiology and Department of Health Care Management, Chang Gung University (KHH), Taoyuan, Taiwan.

Accepted for publication July 10, 2003.

*Current address: Department of Pediatrics, I-Lan Hospital, I-Lan, Taiwan.

†Current address: Department of Pediatrics, National Taiwan University Hospital, Medical College, National Taiwan University, Taipei, Taiwan.

Address for reprints: Dr. Luan-Yin Chang, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University, 5 Fu-Hsin Street, Kwei-Shan Hsiang, Taoyuan County, Taiwan. Fax 886-3-3288957; E-mail ly7077@tpts6.seed.net.tw.

© 2003 Lippincott Williams & Wilkins, Inc.