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Research Article
Clinical Characteristics of Severe Neonatal Enterovirus Infection: A Systematic Review
Jun Tang
West China Second Hospital, Sichuan University
Corresponding Author
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Background: Enterovirus (EV) is a common cause of infection in neonates. Neonates are at high risk of enterovirus infection with serious clinical manifestations and high mortality. This review systematically summarized the clinical characteristics of neonates with severe enteroviral infection to provide evidence for the identification and treatment of severe neonatal EV infection.
Methods: PubMed, Embase, and Web of Science were searched for original studies on neonates with severe EV infections from January 1, 2000, to November 27, 2020. Two reviewers independently screened the literature, extracted the data, and performed a descriptive analysis.
Results: In total, 66 articles with 237 cases of severe neonatal enterovirus infection were included. All patients developed severe complications. Among them, 46.0% patients had hepatitis or coagulopathy, 37.1% had myocarditis, 11.0% had meningoencephalitis, and 5.9% had other complications such as hemophagocytic lymphohistiocytosis and pulmonary hemorrhage. The mortality rate of patients with severe infection was 30.4%. The highest mortality rate was 38.6%, which was observed in patients with myocarditis. In 70.5% patients, the age at the onset of symptoms was less than 7 days. Coxsackievirus B infection was seen in 52.3% patients. The most common symptoms included temperature abnormalities (127, 53.6%), rash (88, 37.1%), poor feeding (58, 24.5%), and respiratory symptoms (52, 21.9%). The main treatment included transfusion of blood components (42.2%), intravenous immunoglobulin (IVIG; 40.9%), mechanical ventilation (21.5%), and extracorporeal membrane oxygenation (ECMO; 18.1%). Additionally, antiviral medications pleconaril (14, 5.9%) and pocapavir (3, 1.3%) were administered.
Conclusions: Mortality was high in patients with severe enterovirus infection, especially in those complicated with myocarditis. The most common symptoms included temperature abnormalities, rash, and poor feeding. The chief supportive treatment consisted of transfusion of blood components, mechanical ventilation, and ECMO. IVIG were widely used. Antiviral medications included pocapavir and pleconaril; however, more clinical evidence regarding their efficacy is needed.
Keywords
Enterovirus infection, neonates, severe, mortality, complications, clinical characteristics
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Reviewer #2 agreed
On 04 Jan, 2021
Reviewer #9 agreed
On 04 Jan, 2021
Reviewer #8 agreed
On 04 Jan, 2021
Reviewer #5 agreed
On 04 Jan, 2021
Reviewer #7 agreed
On 04 Jan, 2021
Reviewer #3 agreed
On 04 Jan, 2021
Reviewer #1 agreed
On 04 Jan, 2021
Reviewer #6 agreed
On 04 Jan, 2021
Reviewers invited
Invitations sent on 01 Jan, 2021
Editor assigned
On 31 Dec, 2020
Editor invited
On 30 Dec, 2020
Submission checks complete
On 30 Dec, 2020
First submitted
On 23 Dec, 2020
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Pediatrics
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This preprint is under consideration at BMC Pediatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Clinical Characteristics of Severe Neonatal Enterovirus Infection: A Systematic Review
Jun Tang
West China Second Hospital, Sichuan University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 04 Jan, 2021
No community comments so far
Review #7 received
Received 06 Jan, 2021
Review #6 received
Received 06 Jan, 2021
Review #3 received
Received 06 Jan, 2021
Review #5 received
Received 06 Jan, 2021
Review #1 received
Received 06 Jan, 2021
Review #4 received
Received 06 Jan, 2021
Reviewer #2 agreed
On 04 Jan, 2021
Reviewer #9 agreed
On 04 Jan, 2021
Reviewer #8 agreed
On 04 Jan, 2021
Reviewer #5 agreed
On 04 Jan, 2021
Reviewer #7 agreed
On 04 Jan, 2021
Reviewer #3 agreed
On 04 Jan, 2021
Reviewer #1 agreed
On 04 Jan, 2021
Reviewer #6 agreed
On 04 Jan, 2021
Reviewers invited
Invitations sent on 01 Jan, 2021
Editor assigned
On 31 Dec, 2020
Editor invited
On 30 Dec, 2020
Submission checks complete
On 30 Dec, 2020
First submitted
On 23 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Enterovirus (EV) is a common cause of infection in neonates. Neonates are at high risk of enterovirus infection with serious clinical manifestations and high mortality. This review systematically summarized the clinical characteristics of neonates with severe enteroviral infection to provide evidence for the identification and treatment of severe neonatal EV infection.
Methods: PubMed, Embase, and Web of Science were searched for original studies on neonates with severe EV infections from January 1, 2000, to November 27, 2020. Two reviewers independently screened the literature, extracted the data, and performed a descriptive analysis.
Results: In total, 66 articles with 237 cases of severe neonatal enterovirus infection were included. All patients developed severe complications. Among them, 46.0% patients had hepatitis or coagulopathy, 37.1% had myocarditis, 11.0% had meningoencephalitis, and 5.9% had other complications such as hemophagocytic lymphohistiocytosis and pulmonary hemorrhage. The mortality rate of patients with severe infection was 30.4%. The highest mortality rate was 38.6%, which was observed in patients with myocarditis. In 70.5% patients, the age at the onset of symptoms was less than 7 days. Coxsackievirus B infection was seen in 52.3% patients. The most common symptoms included temperature abnormalities (127, 53.6%), rash (88, 37.1%), poor feeding (58, 24.5%), and respiratory symptoms (52, 21.9%). The main treatment included transfusion of blood components (42.2%), intravenous immunoglobulin (IVIG; 40.9%), mechanical ventilation (21.5%), and extracorporeal membrane oxygenation (ECMO; 18.1%). Additionally, antiviral medications pleconaril (14, 5.9%) and pocapavir (3, 1.3%) were administered.
Conclusions: Mortality was high in patients with severe enterovirus infection, especially in those complicated with myocarditis. The most common symptoms included temperature abnormalities, rash, and poor feeding. The chief supportive treatment consisted of transfusion of blood components, mechanical ventilation, and ECMO. IVIG were widely used. Antiviral medications included pocapavir and pleconaril; however, more clinical evidence regarding their efficacy is needed.
Figure 1