Enterovirus Infection In Febrile Neonates:A Hospital-based Prospective Cohort Study

Purpose:This study aims to investigate the incidence,clinical manifestation and the risk factors of neonatal enterovirus(EV)infection during the peak season of enterovirus activity.Risk factors for enterovirus infection offer prognostic information about the probability of developing the complication in individual patients as well as in population,help to understand some of the mechanisms that may predispose to enterovirus infection,may lead to effective prophylaxis and may allow risk stratification to target high-risk patients for prevention strategies.Methods:A prospective cohort study was conducted on 334 febrile patients during the summer and fall of 2011 and 2012 years.They were divided into two groups:(1)patients with enterovirus infection,and(2)patients without enterovirus infection.Enterovirus RNA was detected by reverse transcription polymerase chain reaction(RT-PCR)in all febrile patients on feces or cerebrospinal fluid(CSF).The diagnosis of enterovirus infection was proven by a positive enterovirus real-time RT-PCR on feces or cerebrospinal fluid.Meanwhile,clinical data(gestational age,sex,birth weight,age of onset,preterm,vaginal delivery,premature rapture of membrane,breastfeeding,age of mother,highest temperature,duration of fever,maternal history of fever,white blood cells,haemoglobin,thrombocytopenia,C-reactive protein,albumin,total serum bilirubin,glutamic-pyruvic transaminase,creatinine,blood urea nitrogen(BUN),creatine kinase MB isoenzyme(CKMB),abnormal CSF test,positive bacterial culture,hospital length of stay)of two groups were statistically analyzed to understand the clinical features and determine independent predictors for neonatal enterovirus infection.Results:There were 131 episodes of neonatal enterovirus infection(39.22%).Among the 131 neonates infected with enterovirus,cerebrospinal fluid specimens were positive for enterovirus RNA in 44.27%(58/131)whose CSF revealed a mean white blood cell(WBC)counts of 100.38±147.97 cells/mm3(range:2-668 cells/mm3).The positivity of stool 38.92%(130/334)and CSF specimens 26.24%(58/221)for enterovirus RNA,the rate was significantly higher for the stool specimens(X2=9.543,P<0.01;OR:1.791;95%CI:1.235-2.597).By logistic regression analysis the following independently predicted enterovirus infection:abnormal CSF test(OR:12.426,95%Cl:5.633-27.413),thrombocytopenia(OR:3.647,95%CI:1.312-10.136),duration of fever>3.25(d)(OR:2.293,95%CI:1.279-4.113),highest temperature>38.35(°C)(OR:2.094,95%CI:1.342-4.123)and negative bacterial culture(OR:5.073,95%CI:1.504-17.114).Conclusions:1.Our data indicated that enteroviruses should be routinely considered in the differential diagnosis of febrile neonates,especially during enterovirus season.2.The risk factors of neonatal enterovirus infection were abnormal CSF test,thrombocytopenia,duration of fever>3.25(d),highest temperature>38.35(°C)and negative bacterial culture.