Neonatal Myocarditis Research Articles

Treatment with intravenous immunoglobulin in a subclinical neonatal myocarditis – Review of the literature and a case report

Myocarditis is an inflammatory disease of the myocardium that is associated with significant morbidity and mortality. We present the case of a male infant born at 38 weeks gestational age detected with subclinical myocarditis. The diagnosis was suggested by the raised cardiac enzymes, small voltages on electrocardiogram and biventricular hypertrophy on echocardiography. The newborn was managed with supportive, immunomodulatory therapy, diuretics and anti-platelet agents (Aspirin). Early intravenous immunoglobulin administration may have helped to reduce morbidity and mortality, even if administration of intravenous immunoglobulin is not yet clearly established in the neonatal population.

Neonatal myocarditis that needed to be differentiated from myocardial ischemia.

Neonatal myocarditis that needed to be differentiated from myocardial ischemia.

Neonatal Myocarditis: A Review

Neonatal myocarditis is a rare and life-threatening disease with clinical symptoms suggesting bacterial sepsis, accompanied by congestive heart failure, cardiogenic shock and arrhythmias. Enteroviruses and adenoviruses are the most frequent pathogens isolated in myocarditis in neonate. Due to extensive myocyte necrosis in the left ventricle, symptoms may mimic myocardial infarction and circulatory collapse. The diagnosis is suggested by an ischaemic electrocardiogram, raised cardiac enzymes and left ventricular dysfunction. These infants are best managed by early recognition of heart failure, avoidance of hypotension and transfer to an ECMO center. No specific antiviral treatment exists for neonatal myocarditis. Even in the presence of sufficient respiratory and circulatory support, the mortality among neonates with viral myocarditis is high. Majority of survivors develop serious cardiac sequelae. Since neonatal myocarditis is a devastating disease and is not often in the differential diagnosis of neonatal collapse, clinicians should keep a high index of suspicion.
 DS (Child) H J 2019; 35(1) : 70-73

Enteroviral myocarditis in neonates

Enteroviruses are a leading cause of viral infections in children. While most enteroviral infections are mild and self-limiting, severe disease such as a viral sepsis syndrome, myocarditis, hepatitis and meningoencephalitis may occur. We present two cases of neonatal enteroviral myocarditis. Cardiorespiratory failure occurred in both cases, and severe shock refractory to conventional treatment required support with extracorporeal membrane oxygenation (ECMO). One child with coxsackievirus B3 myocarditis failed to recover and died after 3 weeks on ECMO, while one child could be decannulated successfully after 9 days of ECMO and recovered completely subsequently. In conclusion, neonatal myocarditis has a very high mortality, and ECMO should be considered early in neonates with rapid clinical and echocardiographic deterioration despite adequate inotropic support.

重症左心不全に対し，バルーン心房中隔裂開術を施行し救命し得た新生児心筋炎の1 例

重症左心不全に対し，バルーン心房中隔裂開術を施行し救命し得た新生児心筋炎の1 例

Index of Suspicion in The Nursery

A 4-day-old male infant presents in late November to the pediatrics clinic with decreased activity and poor feeding. The mother reports that he had been feeding and acting well until 1 day before presentation. The mother states that he has not had any rhinorrhea, nasal congestion, cough, vomiting, diarrhea, rash, or any atypical movements that could be seizures. She had not taken his temperature, and she states that he has not felt hot. The pediatrician becomes immediately concerned as she recognizes a lethargic infant in respiratory distress. A code is called, and the resuscitation is begun. The infant was a 3,083-g product of a 38+1 week gestation to a 28-year-old G2P1 woman. The pregnancy was only complicated by a positive group B streptococcus screen at 35 weeks' gestation and a history of herpes simplex virus in the past, but no lesions were noted before or during delivery. On presentation to labor and delivery, the fetus was noted to be tachycardic and the mother had mild abdominal tenderness, leading to initiation of ampicillin and gentamicin 16 hours before delivery. The duration of rupture of membranes was 4 hours. The infant was born via spontaneous vaginal delivery and was vigorous, with Apgar scores of 9 and 9 at 1 and 5 minutes. Because the mother was neither febrile nor tachycardic, it was decided that she did not have chorioamnionitis, so the infant received no further laboratory evaluation or antibiotics. The mother and infant were discharged from the hospital after 2 uneventful days. In the clinic, the 4-day-old infant has initial vital signs that included a temperature of 98.9°F, a heart rate of 170 beats per minute, a respiratory rate of 71 breaths per minute, an oxygen saturation (SaO2) of 80% on room air, and blood pressure 84/35 mm …

Enteroviral Sepsis and Ischemic Cardiomyopathy in a Neonate: Case Report and Review of Literature

Neonatal entero-viral sepsis is a rare but fulminant infection with multisystem involvement, often presenting with hepatitis, meningo-encephalitis, disseminated intravascular coagulation (DIC), and myocarditis. Neonatal myocarditis often proves fatal. We report here a case of neonatal enteroviral myocarditis with multisystem organ failure and ischemic cardiomyopathy that was managed medically.

A case of neonatal myocarditis treated with isoproterenol

A case of neonatal myocarditis treated with isoproterenol

Intrathoracic Neuroblastoma Presenting with Neonatal Cardiorespiratory Distress

We report an unusual presentation of congenital intrathoracic neuroblastoma. Severe respiratory distress was present at birth and several salient clinical signs were suggestive of neonatal myocarditis. Excessive catecholamine secretions may have caused the observed cardiac dysfunction. Peculiar previously unreported cutaneous lesions were also noted in this case.

COXSACKIE-B-VIRUS-SPECIFIC IgM RESPONSES IN CHILDREN WITH INSULIN-DEPENDENT (JUVENILE-ONSET; TYPE I) DIABETES MELLITUS

Coxsackie B1-6 virus IgM responses were detected by an enzyme-linked immunosorbent assay (ELISA) in 11 of 28 (39%) children aged 3-14 years in whom insulin-dependent (juvenile onset; type I) diabetes mellitus (IDDM) developed in 1982. 5 patients had a homotypic response to Coxsackie B4 and 1 had a homotypic response to B5. A serum sample had been obtained from each patient 2 to 16 weeks after onset of IDDM symptoms. Islet-cell cytoplasmic antibodies (IgG) and complement fixing islet cell antibodies were detected in 15 of 18 sera tested, but only 6 of these sera were positive for Coxsackie-B-virus-specific IgM which suggests that Coxsackie-B-virus and islet-cell antibodies are not cross-reactive. Coxsackie-B-virus-specific IgM responses were present in only 16 of 290 (5·5%) age-matched non-diabetic London children whose sera were also collected during 1982. Sera from children with virologically confirmed Coxsackie-B-virus infections showed that development of homotypic or heterotypic Coxsackie B1-6 responses was age-related. 29 of 36 (81%) children aged 6 months to 4 years had a homotypic response, whereas 44 of 57 (77%) persons aged 15 years had heterotypic responses. Mothers of 2 children with Coxsackie-B-virus-induced neonatal myocarditis had Coxsackie-B-virus-specific IgM responses directed against serotypes 3 and 4, whereas their infants had a response to Coxsackie B2 virus alone.

Echo 11 virus outbreak in a nursery associated with myocarditis.

SYNOPSIS An outbreak involving 9 proven cases of ECHO II Virus infection in a neonatal nursery containing 20 infants is recorded. The modes of presentation and the short term prognosis are discussed. The possible association with neonatal myocarditis in 5 infants is presented.

Coxsackie group B fatal neonatal myocarditis associated with cardiomegaly.

Most fatal cases of Coxsackie group B neonatal myocarditis have been associated with nursery epidemics. Occasional sporadic cases have been reported, mainly from the U.S.A., and a further case with gross cardiomegaly is described.

Neonatal myocarditis and meningoencephalitis due to Coxsackie virus group B, type 4; virologic study of a fatal case with simultaneous aseptic meningitis in the mother.

A RECENT report1 described the simultaneous occurrence of aseptic meningitis in a woman at term and fatal meningoencephalitis with myocarditis in her newborn infant. It is the purpose of this report to provide details pertinent to the laboratory diagnosis of this infant's disease, which were not included in the original report, and to document relative immunologic maturity in this newborn infant.Clinical AbstractsThe clinical records presented in detail elsewhere1 are briefly summarized. A twenty-two-year-old woman was admitted to the hospital in Honolulu, Hawaii, at term with chills, fever and severe frontal headache. Nasal congestion and a nonproductive cough had . . .