Cerebral imaging and neurodevelopmental outcome after entero- and human parechovirus sepsis in young infants

Erika P. M. van Elzakker,Enrico Lopriore,Herma C. Holscher,Sylke J. Steggerda,Eveline P. de Jong,Jeanine M. M. Van Klink,Frank Brus,Frans J. Walther

doi:10.1007/s00431-017-2981-1

Erika P. M. van Elzakker, Enrico Lopriore + Show 6 more

Open Access

https://doi.org/10.1007/s00431-017-2981-1

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Abstract

Enterovirus (EV) and human parechovirus (HPeV) are major causes of sepsis-like illness in infants under 90 days of age and have been identified as neurotropic. Studies about acute and long-term neurodevelopment in infants with sepsis-like illness without the need for intensive care are few. This study investigates cerebral imaging and neurodevelopmental outcome following EV and HPeV infection in these infants. We studied infants under 90 days of age who were admitted to a medium care unit with proven EV- or HPeV-induced sepsis-like illness. In addition to standard care, we did a cerebral ultrasound and cerebral magnetic resonance imaging (MRI), as well as neurodevelopmental follow-up at 6 weeks and 6 months and Bayley Scale of Infant and Toddler Development 3rd edition (BSID-III) investigation at 1 year of age. Twenty-six infants, 22 with EV and 4 with HPeV, were analysed. No abnormalities were detected at cerebral imaging. At 1 year of age, two infants had a moderate delay on both the motor and cognitive scale, one on the cognitive scale only and three others on the gross motor scale only.Conclusion: Although our study population, especially the number of HPeV positive infants is small, our study shows that these infants do not seem to develop severe neurodevelopmental delay and neurologic sequelae more often than the normal Dutch population. Follow-up to school age allows for more reliable assessments of developmental outcome and is recommended for further studies to better assess outcome.What is known:• Enterovirus and Human Parechovirus infections are a major cause of sepsis-like illness in young infants.• After intensive care treatment for EV or HPeV infection, white matter abnormalities and neurodevelopmental delay have been described.What is new:• In our ‘medium care’ population, no abnormalities at cerebral imaging after EV- or HPeV-induced sepsis-like illness have been found.• At 1 year of age, infants who had EV- or HPeV-induced sepsis-like illness do not seem to develop severe neurodevelopmental delay and neurologic sequelae more often than the normal population.

Highlights

Half of all infants younger than 90 days of age that are hospitalized with sepsis-like illness have an infection with enterovirus (EV) and human parechovirus (HPeV) [1,2,3,4,5]
Conclusion: our study population, especially the number of HPeV positive infants is small, our study shows that these infants do not seem to develop severe neurodevelopmental delay and neurologic sequelae more often than the normal Dutch population
Enterovirus and Human Parechovirus infections are a major cause of sepsis-like illness in young infants

Summary

Introduction

Half of all infants younger than 90 days of age that are hospitalized with sepsis-like illness have an infection with enterovirus (EV) and human parechovirus (HPeV) [1,2,3,4,5]. Both EVand HPeV have been identified as neurotropic viruses. Most infants diagnosed with EV- or HPeVinduced sepsis-like illness do not need intensive care treatment In this less severely affected population, only two studies, both over 20 years old, about neurodevelopmental followup and occurrence of neurologic sequelae exist [8, 9]

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