Prognosis for neonates with enterovirus hepatitis and coagulopathy

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Abstract
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. A search of a hospital medical records database and the investigator's files for the period 1983 to 2000 was performed. Patients with onset of enterovirus-associated illness at age < or = 30 days and either (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. Sixteen cases were identified. Symptoms began at a mean of 3.8 days (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 fibrinogen and albumin concentrations. Five patients had myocarditis and 4 had encephalitis. Hemorrhagic complications occurred in 10 (intracranial hemorrhage 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. 1 of 9, P = 0.02) and intracranial hemorrhage (4 of 5 vs. 1 of 8, P = 0.03). Follow-up of 6 survivors revealed normalization of liver function and platelet counts, satisfactory growth and absence of significant medical problems. The case-fatality rate of 31% is evidence of the potentially devastating nature of EHC. Concomitant EHC and myocarditis are especially serious, but the prognosis for children who survive neonatal EHC is generally excellent.