Neonatal enterovirus infections: emphasis on risk factors of severe and fatal infections
Neonatal enterovirus infections: emphasis on risk factors of severe and fatal infections
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DOI：
10.1097/01.inf.0000091294.63706.f3
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发表时间：
2003-10-01
影响因子：
3.6
通讯作者：
Chang, LY
中科院分区：
文献类型：
--
作者：
Lin, TY;Kao, HT;Chang, LY
目标.新生儿肠病毒感染有多种表现，从无症状到致命。了解与重症病例相关的危险因素可能有助于降低肠道病毒相关的发病率和死亡率。从1989年7月到1998年6月，长庚儿童医院的病毒培养证实非脊髓灰质炎肠道病毒感染的新生儿被纳入研究，并分为三组：非特异性发热性疾病，无菌性脑膜炎和肝坏死伴凝血功能障碍（HNC）。分析人口学因素、临床表现、实验室检查和预后，以揭示与临床严重程度和病死率相关的因素。146例患儿中，非特异性发热43例，无菌性脑膜炎61例，HNC 42例。多因素Logistic回归分析显示，早产、母亲有病史、发病年龄早（≤ 7 d）、白色细胞计数高（WBC ≥ 15000/mm 3）、血红蛋白低（≤ 10.7g/dl）是HNC的主要危险因素。42例病例中有10例（24%）HNC致命。与非致死性HNC病例相比，致死性HNC病例的WBC较高、血红蛋白较低、胆红素较高，并发心肌炎的发生率较高。多变量分析显示，与HNC死亡率相关的最重要因素是总胆红素>4.3 mg/dl（校正比值比，29.1; 95%置信区间，2.5 - 355.5; P = 0.007）和并发心肌炎（校正比值比，13.7; 95%置信区间，1.1 - 177.2; P = 0.04）。静脉注射免疫球蛋白与HNC患者的临床结局无关。早产、母亲病史、发病年龄早、WBC升高和血红蛋白降低是HNC的显著相关因素;总胆红素升高和并发心肌炎与HNC的病死率最显著相关。
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 (less than or equal to7 days), higher white blood cell count (WBC greater than or equal to15 000/mm(3)) and lower hemoglobin (less than or equal to10.7 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 >4.3 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.