Prognosis for neonates with enterovirus hepatitis and coagulopathy

Pediatr Infect Dis J. 2001 Aug;20(8):758-63. doi: 10.1097/00006454-200108000-00008.

Abstract

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 < or = 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Coagulation Disorders / etiology*
  • Blood Coagulation Disorders / mortality*
  • Enterovirus B, Human*
  • Enterovirus Infections / complications*
  • Enterovirus Infections / mortality
  • Female
  • Hepatitis, Viral, Human / complications*
  • Hepatitis, Viral, Human / mortality*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Prognosis
  • Retrospective Studies