Neonatal Enterovirus Infections: Emphasis on Risk Factors of Severe and Fatal Infections
Resource
PEDIATRIC INFECTIOUS DISEASE JOURNAL v.22 n.10 pp.889-894
Journal
PEDIATRIC INFECTIOUS DISEASE JOURNAL
Journal Volume
v.22
Journal Issue
n.10
Pages
889-894
Date Issued
2003
Date
2003
Author(s)
LIN, TZOU-YIEN
KAO, HSIU-TSUN
HSIEH, SHANG-HONG
HUANG, YHU-CHERING
CHIU, CHENG-HSUN
CHOU, YI-HONG
YANG, PENG-HONG
LIN, REY-IN
TSAO, KUO-CHIEN
HSU, KUANG-HUNG
CHANG, LUAN-YIN
Abstract
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.
Subjects
Enterovirus
neonate
hepatic necrosis
myocarditis
risk factor
fatality
SDGs
Type
journal article