Neonatal enterovirus infections: emphasis on risk factors of severe and fatal infections
Journal
Pediatric Infectious Disease Journal
Journal Volume
22
Journal Issue
10
Pages
889-895
Date Issued
2003
Author(s)
Lin T.Y.
Kao H.T.
Hsieh S.H.
Huang Y.C.
Chiu C.H.
Chou Y.H.
Yang P.H.
Lin R.I.
Tsao K.C.
Hsu K.H.
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. ? 2003 Lippincott Williams and Wilkins, Inc.
Subjects
Enterovirus; Fatality; Hepatic necrosis; Myocarditis; Neonate; Risk factor
SDGs
Other Subjects
bilirubin; hemoglobin; immunoglobulin; article; aseptic meningitis; blood clotting disorder; clinical feature; disease severity; Enterovirus; Enterovirus infection; fatality; female; fever; human; incidence; leukocyte count; liver necrosis; major clinical study; male; maternal disease; morbidity; mortality; myocarditis; newborn; newborn infection; onset age; prematurity; priority journal; risk factor; Antiviral Agents; Cause of Death; Cohort Studies; Enterovirus; Enterovirus Infections; Female; Humans; Immunoglobulins, Intravenous; Incidence; Male; Multivariate Analysis; Probability; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Distribution; Survival Analysis; Taiwan; Viremia
Type
journal article