Abstract
BackgroundEnterovirus (EV) is a common cause of infection in neonates. Neonates are at high risk of enterovirus infection with serious clinical manifestations and high lethality. This review systematically summarized the clinical characteristics of neonates with severe enteroviral infection to provide evidence for the identification and treatment of severe neonatal EV infection.MethodsPubMed, Embase, and Web of Science were searched for original studies on neonates with severe EV infections from January 1, 2000, to November 27, 2020. Two reviewers independently screened the literature, extracted the data, and performed a descriptive analysis.ResultsIn total, 66 articles with 237 cases of severe neonatal enterovirus infection were included. All neonates developed severe complications. Among them, 46.0% neonates had hepatitis or coagulopathy, 37.1% had myocarditis, 11.0% had meningoencephalitis, and 5.9% had other complications such as hemophagocytic lymphohistiocytosis and pulmonary hemorrhage. The lethality rate of neonates with severe infection was 30.4%. The highest lethality rate was 38.6%, which was observed in neonates with myocarditis. In 70.5% neonates, the age at the onset of symptoms was less than 7 days. Coxsackievirus B infection was seen in 52.3% neonates. The most common symptoms included temperature abnormalities (127, 53.6%), rash (88, 37.1%), poor feeding (58, 24.5%), and respiratory symptoms (52, 21.9%). The main treatment included transfusion of empirical antibiotics (127, 53.6%), blood components (100, 42.2%), intravenous immunoglobulin (IVIG; 97, 40.9%), mechanical ventilation (51, 21.5%), and extracorporeal membrane oxygenation (ECMO; 43, 18.1%). Additionally, antiviral medications pleconaril (14, 5.9%) and pocapavir (3, 1.3%) were administered.ConclusionsLethality was high in neonates with severe enterovirus infection, especially in those complicated with myocarditis. The most common symptoms included temperature abnormalities, rash, and poor feeding. The chief supportive treatment consisted of transfusion of blood components, mechanical ventilation, and ECMO. Empirical antibiotics and IVIG were widely used. Antiviral medications included pocapavir and pleconaril; however, more clinical evidence regarding their efficacy is needed.
Highlights
Enterovirus (EV) is a common cause of infection in neonates
This study systematically reviewed the clinical characteristics of neonates with severe enteroviral infection, with the aim of gathering information for the identification and treatment of neonatal severe enterovirus infections
66 articles with 237 cases of severe neonatal enterovirus infection were included in the analysis
Summary
Enterovirus (EV) is a common cause of infection in neonates. Neonates are at high risk of enterovirus infection with serious clinical manifestations and high lethality. Enteroviruses affect millions of people worldwide from all age groups. According to the data from the Center for Disease Control and Prevention in America, nonpolio enteroviruses cause 10–15 million infections and tens of thousands of hospitalizations in the United States each year [1]. Disease activity is typically seasonal, and most infections occur in the summer and early fall in temperate parts of the world [2]. Asymptomatic infections account for approximately 50% of the cases [3]. Symptomatic enterovirus infections range from nonspecific febrile illnesses to life-threatening diseases such as myocarditis or sepsis. The main manifestations include hand-foot-mouth disease, acute hemorrhagic conjunctivitis, herpangina, etc. The main manifestations include hand-foot-mouth disease, acute hemorrhagic conjunctivitis, herpangina, etc. [3] Infants and people with weak immune systems have a greater chance of developing severe complications
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