Prognosis for neonates with enterovirus hepatitis and coagulopathy

Background. Neonatal enterovirus hepatitis and coagulopathy (EHC) can be a severe, life-threatening infection. However, the case-fatality rate of EHC and the prognosis for survivors are not well-defined Methods. A search of a hospital medical records database and the investigat or's files for the period 1983 to 2000 was performed. Patients with onset o f enterovirus-associated illness at age less than or equal to 30 days and e ither (1) aspartate aminotransferase or alanine aminotransferase > 3 times the upper limit of normal or (2) platelet count < 100 000 plus an abnormal coagulation profile were included. Results. Sixteen cases were identified. Symptoms began at a mean of 3.8 day s (range, 1 to 7 days). Frequent clinical and laboratory findings included jaundice, lethargy, anorexia, hepatomegaly, thrombocytopenia, clotting time prolongation, elevated transaminase and bilirubin values and decreased fib rinogen and albumin concentrations. Five patients had myocarditis and 4 had encephalitis. Hemorrhagic complications occurred in 10 (intracranial hemor rhage in 5). Five (31%) patients died. Features discriminating patients who died from survivors were concomitant myocarditis (5 of 5 vs. 0 of 11, P < 0.001), encephalitis (3 of 5 vs. 1 of 11, P = 0.06), prothrombin time > 30 s (4 of 5 vs. I of 9, P = 0.02) and intracranial hemorrhage (4 of 5 vs. 1 o f 8, P = 0.03). Follow-up of 6 survivors revealed normalization of liver fu nction and platelet counts, satisfactory growth and absence of significant medical problems. Conclusions. The case-fatality rate of 31% is evidence of the potentially d evastating nature of EHC. Concomitant EHC and myocarditis are especially se rious, but the prognosis for children who survive neonatal EHC is generally excellent.