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

Tzou Yien Lin, Hsiu Tsun Kao, Shang Hong Hsieh, Yhu Chering Huang, Cheng Hsun Chiu, Yi Hong Chou, Peng Hong Yang, Rey In Lin, Kuo Chien Tsao, Kuang Hung Hsu, Luan Yin Chang

Research output: Contribution to journalArticlepeer-review

103 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)889-895
Number of pages7
JournalPediatric Infectious Disease Journal
Issue number10
Publication statusPublished - 2003
Externally publishedYes


  • Enterovirus
  • Fatality
  • Hepatic necrosis
  • Myocarditis
  • Neonate
  • Risk factor

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases


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