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Li J, Xie J, Zhang M, Xiao Z, Zhang F, Huang W, Zhou Y, Yan W, Zhang R, Peng X. Analysis of mild and severe neonatal enterovirus infections in a Chinese neonatal tertiary center: a retrospective case-control study. Eur J Clin Microbiol Infect Dis 2024; 43:1119-1125. [PMID: 38607576 DOI: 10.1007/s10096-024-04805-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/07/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To compare the clinical characteristics, virus serotype, and outcome in cases of mild and severe enteroviral infection at a tertiary neonatal intensive care unit in China. METHODS A retrospective analysis of cases hospitalized between June and August 2019. Samples (stool or throat swabs) were examined using reverse transcription polymerase chain reaction. Positive cases were divided into two groups: mild infection and severe infection. RESULTS A total of 149 cases were assigned to one of two groups: mild infection (n = 104) and severe infection (n = 45). There were no significant differences between the groups in terms of sex, gestational age, birth weight, mode of delivery, and onset within 7 days. Clinical symptoms in both groups mostly resembled sepsis (fever, rash, poor feeding, and lethargy); however, there were significant variations in concomitant symptoms such as hepatitis, thrombocytopenia, encephalitis, coagulopathy, and myocarditis. Severe cases were more likely to have abnormal complete blood counts, biochemical parameters, and cerebrospinal fluid markers. The predominant serotypes implicated in neonatal enterovirus infections were echoviruses and Coxsackievirus B. Invasive ventilation, intravenous immunoglobulin, vasoactive medications, and blood product transfusions were often required, with high mortality rates among severe cases. CONCLUSION We found significant differences between mild and severe cases of neonatal enterovirus infection with respect to complications, laboratory findings, and enterovirus serotypes. It is crucial to exercise caution when newborns exhibit symptoms of sepsis, during an enterovirus outbreak. Anemia, thrombocytopenia, abnormal liver function, and coagulation dysfunction should be monitored closely as they could indicate the presence of a severe enteroviral infection.
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Affiliation(s)
- Junshuai Li
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jingjing Xie
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Min Zhang
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhuojun Xiao
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Fan Zhang
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Weiqing Huang
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yong Zhou
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Weiqun Yan
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Rong Zhang
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xiaoming Peng
- Department of Neonatology, Hunan Children's Hospital, Changsha, China.
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
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Thampi N, Guzman-Cottrill J, Bartlett AH, Berg W, Cantey JB, Kitt E, Ravin K, Zangwill KM, Elward A. SHEA NICU white paper series: Practical approaches for the prevention of viral respiratory infections. Infect Control Hosp Epidemiol 2024; 45:267-276. [PMID: 37877172 DOI: 10.1017/ice.2023.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
This white paper provides clinicians and hospital leaders with practical guidance on the prevention and control of viral respiratory infections in the neonatal intensive care unit (NICU). This document serves as a companion to Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee (HICPAC)'s "Prophylaxis and Screening for Prevention of Viral Respiratory Infections in Neonatal Intensive Care Unit Patients: A Systematic Review." It provides practical, expert opinion and/or evidence-based answers to frequently asked questions about viral respiratory detection and prevention in the NICU. It was developed by a writing panel of pediatric and pathogen-specific experts who collaborated with members of the HICPAC systematic review writing panel and the SHEA Pediatric Leadership Council to identify questions that should be addressed. The document has been endorsed by SHEA, the American Hospital Association (AHA), The Joint Commission, the Pediatric Infectious Diseases Society (PIDS), the Association for Professionals in Infection Control and Epidemiology (APIC), the Infectious Diseases Society of America (IDSA), and the National Association of Neonatal Nurses (NANN).
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Affiliation(s)
- Nisha Thampi
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Allison H Bartlett
- University of Chicago and Comer Children's Hospital, Chicago, Illinois, USA
| | - Wendy Berg
- Children's Minnesota, St. Paul, Minnesota, USA
| | - Joseph B Cantey
- The University of Texas Health Science Center, San Antonio, Texas, USA
| | - Eimear Kitt
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Karen Ravin
- Nemours Children's Health, Wilmington, Delaware, USA
| | | | - Alexis Elward
- Washington University School of Medicine, St. Louis, Missouri, USA
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3
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Moliner-Calderón E, Rabella-Garcia N, Turón-Viñas E, Ginovart-Galiana G, Figueras-Aloy J. Relevance of enteroviruses in neonatal meningitis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:17-23. [PMID: 36624031 DOI: 10.1016/j.eimce.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/29/2022] [Accepted: 07/20/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Enterovirus (EV) infections are the most frequent infections in the neonatal period and in many cases lead to hospital admission of the newborn (NB). The aim of this study was to determine the incidence of EV in the etiology of neonatal meningitis and to define the clinical characteristics of newborns with EV meningitis. MATERIAL AND METHOD Retrospective observational cohort study. Including 91 NBs with meningitis and gestational age greater than 34 weeks gestational age (GA) attended in our center over a period of 16 years. RESULTS The percentage of NBs with EV meningitis was higher than that of NBs with bacterial meningitis (BM) and accounted for 78% (n=71). Half of the NBs with EV infection had a history of epidemic environment among their caregivers. Fever was present in 96% of cases as a clinical sign and, in general, sensory disturbances represented the main neurological alterations. Antibiotics (ATB) were given to 71.4% of patients with EV infection. Detection of EV in CSF samples showed a high sensitivity for the diagnosis of EV meningitis. The most frequently implicated EV types were echovirus 11, coxsackievirus B5, echovirus 18, 25 and 7. CONCLUSIONS The results of this series show that enterovirus infection is a common cause of neonatal meningitis. These data underline the importance of rapid EV testing of infants with suspected meningitis. This allows early diagnosis and reduces antibiotic treatment, hospitalization time and related costs.
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Affiliation(s)
- Elisenda Moliner-Calderón
- Unidad de Neonatología, Pediatría, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Núria Rabella-Garcia
- Sección de Virología, Microbiología, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eulalia Turón-Viñas
- Unidad de Neonatología, Pediatría, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Josep Figueras-Aloy
- Unidad de Neonatología, ICGON, Hospital Clínic, BCNatal, Associació Sanitària Hospital Clínic-Hospital Sant Joan de Déu, Barcelona, Spain
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4
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Tomatis Souverbielle C, Erdem G, Sánchez PJ. Update on nonpolio enterovirus and parechovirus infections in neonates and young infants. Curr Opin Pediatr 2023; 35:380-389. [PMID: 36876331 DOI: 10.1097/mop.0000000000001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
PURPOSE OF REVIEW To review the epidemiology, clinical manifestations, and treatment strategies of nonpolio enterovirus and parechovirus (PeV) infections, and identify research gaps. RECENT FINDINGS There is currently no approved antiviral agent for enterovirus or PeV infections, although pocapavir may be provided on a compassionate basis. Elucidation of the structure and functional features of enterovirus and PeV may lead to novel therapeutic strategies, including vaccine development. SUMMARY Nonpolio human enterovirus and PeV are common childhood infections that are most severe among neonates and young infants. Although most infections are asymptomatic, severe disease resulting in substantial morbidity and mortality occurs worldwide and has been associated with local outbreaks. Long-term sequelae are not well understood but have been reported following neonatal infection of the central nervous system. The lack of antiviral treatment and effective vaccines highlight important knowledge gaps. Active surveillance ultimately may inform preventive strategies.
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Affiliation(s)
| | - Guliz Erdem
- Department of Pediatrics, Section of Infectious Diseases
| | - Pablo J Sánchez
- Department of Pediatrics, Section of Infectious Diseases
- Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Perinatal Research, The Ohio State University College of Medicine, Columbus, Ohio, USA
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5
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Detection of Parechovirus and Enterovirus Among Infants Evaluated for Late-onset Sepsis in the Neonatal Intensive Care Unit: The Viral Respiratory Infections in the Neonatal Intensive Care Unit-Parechovirus-Enterovirus Study. Pediatr Infect Dis J 2022; 41:1017-1019. [PMID: 36102733 DOI: 10.1097/inf.0000000000003700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In a prospective cohort study of 65 inborn infants who were evaluated for late-onset sepsis at >72 hours of age in 2 academic neonatal intensive care units, none had parechovirus or enterovirus RNA detected by polymerase chain reaction performed on nasopharyngeal specimens during the first or subsequent sepsis evaluations (n = 80).
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6
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Relevancia de los enterovirus en la meningitis neonatal. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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7
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Grobben M, Juncker HG, van der Straten K, Lavell AHA, Schinkel M, Buis DTP, Wilbrink MF, Tejjani K, Claireaux MAF, Aartse A, de Groot CJM, Pajkrt D, Bomers MK, Sikkens JJ, van Gils MJ, van Goudoever JB, van Keulen BJ. Decreased Passive Immunity to Respiratory Viruses through Human Milk during the COVID-19 Pandemic. Microbiol Spectr 2022; 10:e0040522. [PMID: 35762813 PMCID: PMC9431045 DOI: 10.1128/spectrum.00405-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/11/2022] [Indexed: 11/20/2022] Open
Abstract
Infants may develop severe viral respiratory tract infections because their immune system is still developing in the first months after birth. Human milk provides passive humoral immunity during the first months of life. During the COVID-19 pandemic, circulation of common respiratory viruses was virtually absent due to the preventative measures resulting in reduced maternal exposure. Therefore, we hypothesized that this might result in lower antibody levels in human milk during the pandemic and, subsequently, decreased protection of infants against viral respiratory tract infections. We assessed antibody levels against respiratory syncytial virus (RSV), Influenza virus, and several seasonal coronaviruses in different periods of the COVID-19 pandemic in serum and human milk using a Luminex assay. IgG levels against RSV, Influenza, HCoV-OC43, HCoV-HKU1, and HCoV-NL63 in human milk were reduced with a factor of 1.7 (P < 0.001), 2.2 (P < 0.01), 2.6 (P < 0.05), 1.4 (P < 0.01), and 2.1 (P < 0.001), respectively, since the introduction of the COVID-19 restrictions. Furthermore, we observed that human milk of mothers that experienced COVID-19 contained increased levels of IgG and IgA binding to other respiratory viruses. Passive immunity via human milk against common respiratory viruses was reduced during the COVID-19 pandemic, which may have consequences for the protection of breastfed infants against respiratory infections. IMPORTANCE Passive immunity derived from antibodies in human milk is important for protecting young infants against invading viruses. During the COVID-19 pandemic, circulation of common respiratory viruses was virtually absent due to preventative measures. In this study, we observed a decrease in human milk antibody levels against common respiratory viruses several months into the COVID-19 pandemic. This waning of antibody levels might partially explain the previously observed surge of hospitalizations of infants, mostly due to RSV, when preventative hygiene measures were lifted. Knowledge of the association between preventative measures, antibody levels in human milk and subsequent passive immunity in infants might help predict infant hospital admissions and thereby enables anticipation to prevent capacity issues. Additionally, it is important in the consideration for strategies for future lockdowns to best prevent possible consequences for vulnerable infants.
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Affiliation(s)
- Marloes Grobben
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Hannah G. Juncker
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Emma Children’s Hospital, University of Amsterdam, Amsterdam, the Netherlands
- Center for Neuroscience, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Karlijn van der Straten
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - A. H. Ayesha Lavell
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michiel Schinkel
- Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - David T. P. Buis
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maarten F. Wilbrink
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Emma Children’s Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Khadija Tejjani
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Mathieu A. F. Claireaux
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Aafke Aartse
- Department of Virology, Biomedical Primate Research Centre, Rijswijk, the Netherlands
| | - Christianne J. M. de Groot
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Dasja Pajkrt
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Emma Children’s Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Marije K. Bomers
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jonne J. Sikkens
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marit J. van Gils
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes B. van Goudoever
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Emma Children’s Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Britt J. van Keulen
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Emma Children’s Hospital, University of Amsterdam, Amsterdam, the Netherlands
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8
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Paul SP, Khattak H, Kini PK, Heaton PA, Goel N. NICE guideline review: neonatal infection: antibiotics for prevention and treatment (NG195). Arch Dis Child Educ Pract Ed 2022; 107:292-297. [PMID: 34772670 DOI: 10.1136/archdischild-2021-322349] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/25/2021] [Indexed: 01/21/2023]
Affiliation(s)
| | | | | | | | - Nitin Goel
- Neonatal Medicine, University Hospital of Wales, Cardiff, UK
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9
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Enterovirus Replication and Dissemination Are Differentially Controlled by Type I and III Interferons in the Gastrointestinal Tract. mBio 2022; 13:e0044322. [PMID: 35604122 PMCID: PMC9239134 DOI: 10.1128/mbio.00443-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Echovirus infections are associated with a broad spectrum of illness, particularly in neonates, and are primarily transmitted through the fecal-oral route. Little is known regarding how echoviruses infect the gastrointestinal tract and how the intestinal epithelium controls echoviral replication.
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10
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Kielt MJ, Murphy A, Smathers J, Bates M, Nelin LD, Shepherd EG. In-hospital respiratory viral infections for patients with established BPD in the SARS-CoV-2 era. Pediatr Pulmonol 2022; 57:200-208. [PMID: 34596351 PMCID: PMC8662151 DOI: 10.1002/ppul.25714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/13/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Our objective was to test the hypothesis that in-hospital respiratory viral infections (RVI) would be significantly lower in a cohort of patients with established bronchopulmonary dysplasia (BPD) exposed to a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prevention protocol when compared to historical controls. STUDY DESIGN On April 1, 2020, we implemented a universal infection prevention protocol to minimize the risk of nosocomial SARS-CoV-2 transmission in a dedicated BPD intensive care unit. We performed a retrospective cohort study and included patients with established BPD, as defined by the 2019 Neonatal Research Network criteria, admitted to our center who underwent real-time polymerase-chain-reaction RVI testing between January 1, 2015 and March 31, 2021. We excluded patients readmitted from home. We compared the proportion of positive tests to the number of tests performed and the distribution of viral respiratory pathogens in the pre- and post-SARS-CoV-2 eras. RESULTS Among 176 patients included in the study, 663 RVI tests were performed and 172 (26%) tests were positive. The median number of tests performed, measured in tests per patient per month, in the SARS-CoV-2 era was not significantly different compared to the pre-SARS-CoV-2 era (0.45 vs. 0.34 tests per patient per month, p = .07). The proportion of positive RVI tests was significantly lower in the SARS-CoV-2 era when compared to the pre-SARS-CoV-2 era (0.06 vs. 0.30, p < .0001). No patients tested positive for SARS-CoV-2 in the SARS-CoV-2 era. CONCLUSIONS Infection prevention measures developed in response to the SARS-CoV-2 pandemic may reduce the risk of RVIs in hospitalized patients with established BPD.
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Affiliation(s)
- Matthew J Kielt
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Angela Murphy
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jodi Smathers
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - MaLeah Bates
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leif D Nelin
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, Ohio, USA.,Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Edward G Shepherd
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, Ohio, USA
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11
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Hanley S, Odeniyi F, Feemster K, Coffin SE, Sammons JS. Epidemiology and Risk Factors for Healthcare-Associated Viral Infections in Children. J Pediatric Infect Dis Soc 2021; 10:941-950. [PMID: 34313773 DOI: 10.1093/jpids/piab015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Healthcare-associated viral infections (HA-VIs) are common in hospitalized children and are increasingly recognized as a cause of preventable harm; however, the epidemiology and modifiable risk factors for pediatric HA-VIs are poorly understood. METHODS We performed a retrospective case-control study to identify risk factors and outcomes associated with pediatric HA-VIs at a quaternary care children's hospital. HA-VI surveillance was performed hospital-wide using Centers for Disease Control and Prevention (CDC) definitions. We abstracted data from the electronic medical record and conducted semi-structured interviews with patient caregivers to identify potential exposures 4 days before the HA-VI onset. RESULTS During the 20-month study period, we identified 143 eligible patients with HA-VIs and enrolled 64 matched case-control pairs. In total, 79 viruses were identified among 64 case patients. During the exposure period, case, as compared with control, patients were more frequently exposed to a sick visitor (odds ratio = 5.19; P = .05). During the 7 days after the HA-VI onset, case, as compared with control, patients had a greater length of antibacterial therapy per patient-days (mean 411 vs 159) as well as greater days of antibacterial therapy per patient-days (mean 665 vs 247). CONCLUSIONS The results of this study show that exposure to a sick visitor is a potentially modifiable risk factor for pediatric HA-VIs. Hospitalized children with HA-VIs also have increased exposure to antibacterial agents when compared with matched controls. Our findings suggest that hospital policies may need to be revised, with emphasis on visitor screening and partnership with families, to reduce the incidence of pediatric HA-VIs during hospitalization.
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Affiliation(s)
- Samantha Hanley
- Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship (IDEAS) Research Program, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Folasade Odeniyi
- Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship (IDEAS) Research Program, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristen Feemster
- Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship (IDEAS) Research Program, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Susan E Coffin
- Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship (IDEAS) Research Program, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA.,Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julia S Sammons
- Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship (IDEAS) Research Program, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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12
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Tong WY, Yung CF, Chiew LC, Chew SB, Ang LD, Thoon KC, Rajadurai VS, Yeo KT. Universal Face Masking Reduces Respiratory Viral Infections Among Inpatient Very-Low-Birthweight Neonatal Infants. Clin Infect Dis 2021; 71:2958-2961. [PMID: 32406498 DOI: 10.1093/cid/ciaa555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/07/2020] [Indexed: 01/19/2023] Open
Abstract
We reviewed the impact of a universal face masking policy on respiratory viral infections (RVIs) among admitted very-low-birthweight infants in our neonatal department. There was a significant decrease in RVI incidence, specifically in our step-down level 2 unit, with respiratory syncytial virus and parainfluenza virus being the most common viruses isolated.
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Affiliation(s)
- Wing Yee Tong
- Department of Neonatology, KK Women's & Children's Hospital, Singapore
| | - Chee Fu Yung
- Infectious Diseases Service, KK Women's & Children's Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
| | - Lee Chern Chiew
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Siong Beng Chew
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Li Duan Ang
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Koh Cheng Thoon
- Infectious Diseases Service, KK Women's & Children's Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore
| | - Victor S Rajadurai
- Department of Neonatology, KK Women's & Children's Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's & Children's Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore
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13
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Schreurs RRCE, Sagebiel AF, Steinert FL, Highton AJ, Klarenbeek PL, Drewniak A, Bakx R, The SML, Ribeiro CMS, Perez D, Reinshagen K, Geijtenbeek TBH, van Goudoever JB, Bunders MJ. Intestinal CD8 + T cell responses are abundantly induced early in human development but show impaired cytotoxic effector capacities. Mucosal Immunol 2021; 14:605-614. [PMID: 33772147 PMCID: PMC8075922 DOI: 10.1038/s41385-021-00382-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/30/2020] [Accepted: 11/02/2020] [Indexed: 02/04/2023]
Abstract
Gastrointestinal viral infections are a major global cause of disease and mortality in infants. Cytotoxic CD8+ T cells are critical to achieve viral control. However, studies investigating the development of CD8+ T cell immunity in human tissues early in life are lacking. Here, we investigated the maturation of the CD8+ T cell compartment in human fetal, infant and adult intestinal tissues. CD8+ T cells exhibiting a memory phenotype were already detected in fetal intestines and increased after birth. Infant intestines preferentially harbored effector CCR7-CD45RA-CD127-KLRG1+/- CD8+ T cells compared to tissue-resident memory CD69+CD103+CD8+ T cells detected in adults. Functional cytotoxic capacity, including cytokine and granzyme B production of infant intestinal effector CD8+ T cells was, however, markedly reduced compared to adult intestinal CD8+ T cells. This was in line with the high expression of the inhibitory molecule PD-1 by infant intestinal effector CD8+ T cells. Taken together, we demonstrate that intestinal CD8+ T cell responses are induced early in human development, however exhibit a reduced functionality. The impaired CD8+ T cell functionality early in life contributes to tolerance during foreign antigen exposure after birth, however functions as an immune correlate for the increased susceptibility to gastrointestinal viral infections in infancy.
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Affiliation(s)
- R. R. C. E. Schreurs
- grid.7177.60000000084992262Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam University Medical Center (AUMC), University of Amsterdam (UvA), Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Pediatrics, Emma Children’s Hospital, AUMC, UvA, Amsterdam, The Netherlands
| | - A. F. Sagebiel
- grid.418481.00000 0001 0665 103XHeinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - F. L. Steinert
- grid.418481.00000 0001 0665 103XHeinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - A. J. Highton
- grid.418481.00000 0001 0665 103XHeinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - P. L. Klarenbeek
- grid.7177.60000000084992262Department of Clinical Immunology and Rheumatology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, AUMC, UvA, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology & Immunology Center, AUMC, UvA, Amsterdam, The Netherlands
| | - A. Drewniak
- grid.7177.60000000084992262Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam University Medical Center (AUMC), University of Amsterdam (UvA), Amsterdam, The Netherlands ,grid.467476.00000 0004 0483 1848Kiadis Pharma B.V., Amsterdam, The Netherlands
| | - R. Bakx
- Department of Pediatric Surgery, Pediatric Surgery Center of Amsterdam, AUMC, Amsterdam, The Netherlands
| | - S. M. L. The
- grid.7177.60000000084992262Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam University Medical Center (AUMC), University of Amsterdam (UvA), Amsterdam, The Netherlands ,Department of Pediatric Surgery, Pediatric Surgery Center of Amsterdam, AUMC, Amsterdam, The Netherlands
| | - C. M. S. Ribeiro
- grid.7177.60000000084992262Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam University Medical Center (AUMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - D. Perez
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - K. Reinshagen
- grid.13648.380000 0001 2180 3484Department of Pediatric Surgery, UKE, Hamburg, Germany
| | - T. B. H. Geijtenbeek
- grid.7177.60000000084992262Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam University Medical Center (AUMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - J. B. van Goudoever
- grid.7177.60000000084992262Department of Pediatrics, Emma Children’s Hospital, AUMC, UvA, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Pediatrics, Emma Children’s Hospital, AUMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - M. J. Bunders
- grid.7177.60000000084992262Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam University Medical Center (AUMC), University of Amsterdam (UvA), Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Pediatrics, Emma Children’s Hospital, AUMC, UvA, Amsterdam, The Netherlands ,grid.418481.00000 0001 0665 103XHeinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
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14
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Wells AI, Grimes KA, Kim K, Branche E, Bakkenist CJ, DePas WH, Shresta S, Coyne CB. Human FcRn expression and Type I Interferon signaling control Echovirus 11 pathogenesis in mice. PLoS Pathog 2021; 17:e1009252. [PMID: 33513208 PMCID: PMC7875378 DOI: 10.1371/journal.ppat.1009252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/10/2021] [Accepted: 12/21/2020] [Indexed: 12/12/2022] Open
Abstract
Neonatal echovirus infections are characterized by severe hepatitis and neurological complications that can be fatal. Here, we show that expression of the human homologue of the neonatal Fc receptor (hFcRn), the primary receptor for echoviruses, and ablation of type I interferon (IFN) signaling are key host determinants involved in echovirus pathogenesis. We show that expression of hFcRn alone is insufficient to confer susceptibility to echovirus infections in mice. However, expression of hFcRn in mice deficient in type I interferon (IFN) signaling, hFcRn-IFNAR-/-, recapitulate the echovirus pathogenesis observed in humans. Luminex-based multianalyte profiling from E11 infected hFcRn-IFNAR-/- mice revealed a robust systemic immune response to infection, including the induction of type I IFNs. Furthermore, similar to the severe hepatitis observed in humans, E11 infection in hFcRn-IFNAR-/- mice caused profound liver damage. Our findings define the host factors involved in echovirus pathogenesis and establish in vivo models that recapitulate echovirus disease in humans.
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Affiliation(s)
- Alexandra I. Wells
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- Center for Microbial Pathogenesis, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Kalena A. Grimes
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- Center for Microbial Pathogenesis, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Kenneth Kim
- Kord Animal Health Diagnostic Laboratory, Nashville, Tennessee, United States of America
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology La Jolla, California, United States of America
| | - Emilie Branche
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology La Jolla, California, United States of America
| | - Christopher J. Bakkenist
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - William H. DePas
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- Center for Microbial Pathogenesis, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Sujan Shresta
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology La Jolla, California, United States of America
| | - Carolyn B. Coyne
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- Center for Microbial Pathogenesis, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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15
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van Hinsbergh TMT, Elbers RG, Hans Ket JCF, van Furth AM, Obihara CC. Neurological and neurodevelopmental outcomes after human parechovirus CNS infection in neonates and young children: a systematic review and meta-analysis. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:592-605. [PMID: 32710840 DOI: 10.1016/s2352-4642(20)30181-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Human parechoviruses are a major cause of CNS infection in neonates and young children. They have been implicated in neurological sequelae and neurodevelopmental delay. However, the magnitude of this effect has not been systematically reviewed or assessed with meta-analyses. We investigated short-term, medium-term, and long-term neurological sequelae and neurodevelopmental delay in neonates and young children after parechovirus-CNS-infection. METHODS In this systematic review and meta-analyses of studies, we searched PubMed, Embase, and PsycInfo, from the inception of the database until March 18, 2019, for reviews, systematic reviews, cohort studies, case series, and case control studies reporting on neurological or neurodevelopmental outcomes of children 3 months or younger with parechovirus infection of the CNS. Studies that were published after Dec 31, 2007, assessed children younger than 16 years, detailed parechoviruses infection of the CNS (confirmed by PCR), and followed up on neurological and neurodevelopmental outcomes were included. Studies published before Dec 31, 2007, were excluded. The predefined primary outcomes were the proportions of children with neurological sequelae, impairment in auditory or visual functions, or gross motor function delay. The proportion of children in whom neurological or neurodevelopmental outcomes were reported was pooled in meta-analyses. For each outcome variable we calculated the pooled proportion with 95% CI. The proportion of children in whom neurological or neurodevelopmental outcomes were reported was extracted by one author and checked by another. Two authors independently assessed the methodological quality of the studies. FINDINGS 20 studies were eligible for quantitative synthesis. The meta-analyses showed an increasing proportion of children with neurological sequelae over time: 5% during short-term follow-up (pooled proportion 0·05 [95% CI 0·03-0·08], I2=0·00%; p=0·83) increasing to 27% during long-term follow-up (0·27 [0·17-0·40], I2=52·74%; p=0·026). The proportion of children with suspected neurodevelopmental delay was 9% or more during long-term follow-up. High heterogeneity and methodological issues in the included studies mean that the results should be interpreted with caution. INTERPRETATION This systematic review suggests the importance of long follow-up, preferably up to preschool or school age (5-6 years), of children with parechovirus infection of the CNS. Although not clinically severe, we found an increasing proportion of neonates and young children with CNS infection had associated neurological sequelae and neurodevelopmental delay over time. We recommend the use of standardised methods to assess neurological and neurodevelopmental functions of these children and to compare results with age-matched reference groups. FUNDING No funding was received for this study.
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Affiliation(s)
| | - Roy G Elbers
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - J C F Hans Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - A Marceline van Furth
- Department of Paediatric Infectious Diseases and Immunology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Charlie C Obihara
- Department of Paediatrics, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands
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16
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Abstract
BACKGROUND Culture-negative late-onset sepsis (LOS) is commonly diagnosed in neonatal intensive care units, while the outcomes of neonatal culture-negative LOS are not reported for large cohorts. This study aimed to examine the incidence and neonatal outcomes for culture-negative LOS in a contemporary multicenter cohort of preterm infants. METHODS We performed a retrospective analysis of data from a cluster-randomized controlled study. Infants <34 weeks of gestation and admitted to 25 neonatal intensive care units between May 1, 2015, and April 30, 2018, were included. Culture-negative LOS was diagnosed if infants had abnormal manifestations and laboratory tests but negative blood cultures. The primary outcome was a composite of mortality or morbidities including periventricular leukomalacia (PVL), retinopathy of prematurity (ROP) ≥ stage 3 or bronchopulmonary dysplasia (BPD). RESULTS Of 22,346 eligible infants, 1505 (6.7%) infants had culture-negative and 761 (3.4%) infants had culture-positive LOS. Compared with infants without LOS, infants with culture-negative LOS had higher rates of composite outcome (24.1% vs. 9.6%), death (3.8% vs. 1.8%), PVL (4.8% vs. 2.2%), severe ROP (3.3% vs. 1.1%) and BPD (18.1% vs. 7.0%). After adjustment, culture-negative LOS was independently associated with increased risk of composite outcome {adjusted odds ratio [aOR]: 1.8 [95% confidence interval (CI): 1.5-2.1]}, PVL [aOR: 2.0 (95% CI: 1.4-2.8)] and BPD [aOR: 1.8 (95% CI: 1.5-2.2)] relative to the absence of LOS. CONCLUSION Culture-negative LOS was frequently diagnosed in preterm infants and was associated with increased risks of adverse outcomes. There is an emerging need for more precise diagnosis and treatment strategies for culture-negative LOS.
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17
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Berardi A, Sandoni M, Toffoli C, Boncompagni A, Gennari W, Bergamini MB, Lucaccioni L, Iughetti L. Clinical characterization of neonatal and pediatric enteroviral infections: an Italian single center study. Ital J Pediatr 2019; 45:94. [PMID: 31375127 PMCID: PMC6679433 DOI: 10.1186/s13052-019-0689-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Enteroviruses (EVs) are an important cause of illness, especially in neonates and young infants. Clinical and laboratory findings at different ages, brain imaging, and outcomes have been inadequately investigated. Methods We retrospectively investigated EV infections occurring at an Italian tertiary care center during 2006–2017. Cases were confirmed with a positive polymerase chain reaction on blood or cerebrospinal fluid. Clinical and laboratory findings according to age at presentation were analyzed. Results Among 61 cases of EV infection, 56 had meningitis, 4 had encephalitis, and 1 had unspecific febrile illness. Forty-seven cases (77.0%) presented at less than 1 year of age, and most were less than 90 days of age (n = 44). Presentation with fever (p < 0.01), higher median temperature (p < 0.01), and irritability (p < 0.01) were significantly more common among infants aged less than 90 days, who also had significantly higher peak temperatures during the course of the disease (p < 0.01). In contrast, gastrointestinal symptoms were more common in infants and children aged over 90 days (p = 0.02). Only 4 of 61 infections (6.5%) were severe and all affected younger infants (p < 0.01). Conclusions We detail epidemiological, clinical, and laboratory findings in a cohort of 61 children. Infants aged less than 90 days have more severe disease; they are more likely to present with fever, higher median temperature, and irritability and less likely to develop gastrointestinal symptoms.
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Affiliation(s)
- Alberto Berardi
- Struttura Complessa di Neonatologia, Azienda Ospedaliero-Universitaria Policlinico, Via del Pozzo, 71, 41124, Modena, MO, Italy.
| | - Marcello Sandoni
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy
| | - Carlotta Toffoli
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy
| | - Alessandra Boncompagni
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy
| | - William Gennari
- Struttura Complessa di Microbiologia e Virologia-Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Maria Barbara Bergamini
- Struttura Complessa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Laura Lucaccioni
- Struttura Complessa di Neonatologia, Azienda Ospedaliero-Universitaria Policlinico, Via del Pozzo, 71, 41124, Modena, MO, Italy
| | - Lorenzo Iughetti
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy.,Struttura Complessa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
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18
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Poole CL, Camins BC, Prichard MN, Faye-Petersen O, Hutto C. Hospital-acquired viral respiratory infections in neonates hospitalized since birth in a tertiary neonatal intensive care unit. J Perinatol 2019; 39:683-689. [PMID: 30723275 PMCID: PMC7100243 DOI: 10.1038/s41372-019-0318-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/27/2018] [Accepted: 01/08/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine frequency of hospital-acquired viral respiratory infections (HA-VRI) and associated outcomes in a NICU. STUDY DESIGN Prospective cohort study conducted from 4 October 2016 to 21 March 2017. Infants hospitalized from birth in the NICU had a weekly nasal swab collected for testing using a multiplex PCR assay capable of detecting 16 different respiratory viruses. RESULTS Seventy-four infants enrolled, with 5 (6.8%) testing positive for a virus (incidence rate of 1.3/1000 patient days). VRI positive infants had a younger gestational age (median 27 w vs. 32 w, p = 0.048); were hospitalized longer (97 d vs 43 d, p = 0.013); required more antibiotics (8 d vs. 4 d, p = 0.037) and were more likely to be diagnosed with bronchopulmonary dysplasia (p = 0.008) compared to VRI negative infants. CONCLUSION Respiratory viruses are a frequent cause of HAI in the NICU and are associated with negative outcomes.
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Affiliation(s)
- Claudette L Poole
- Department of Pediatrics, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Bernard C Camins
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark N Prichard
- Department of Pediatrics, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ona Faye-Petersen
- Department of Medicine, Division of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cecelia Hutto
- Department of Pediatrics, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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19
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Thaulow CM, Berild D, Blix HS, Brigtsen AK, Myklebust TÅ, Eriksen BH. Can We Optimize Antibiotic Use in Norwegian Neonates? A Prospective Comparison Between a University Hospital and a District Hospital. Front Pediatr 2019; 7:440. [PMID: 31709209 PMCID: PMC6821648 DOI: 10.3389/fped.2019.00440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Worldwide, a large proportion of neonates are prescribed antibiotics without having infections leading to increased antimicrobial resistance, disturbance of the evolving microbiota, and increasing the risk of various chronical diseases. Comparing practice between different hospitals/settings is important in order to optimize antibiotic stewardship. Aim: To investigate and compare the potential for improved antibiotic stewardship in neonates in two Norwegian hospitals with different academic culture, with emphasis on antibiotic exposure in unconfirmed infections, treatment length/doses, CRP values and the use of broad-spectrum antibiotics (BSA). All types of infections were investigated, but the main focus was on early-onset sepsis (EOS). Methods: We conducted a prospective observational cohort study of antibiotic use in a Norwegian university hospital (UH) and a district hospital (DH), 2017. Unconfirmed infections were defined as culture negative infections that neither fulfilled the criteria for clinical infection (clinical symptoms, maximum CRP >30 mg/L, and treatment for at least 5 days). Results: Ninety-five neonates at the DH and 89 neonates at the UH treated with systemic antibiotics were included in the study. In total, 685 prescriptions (daily doses) of antibiotics were given at the DH and 903 at the UH. Among term and premature infants (≥ 28 weeks), 82% (75% at the UH and 86% at the DH, p = 0.172) of the treatments for suspected EOS were for unconfirmed infections, and average treatment length in unconfirmed infections was 3.1 days (both hospitals). Median dose for aminoglycoside was higher for term infants at the UH (5.96, 95% CI 5.02-6.89) compared to the DH (4.98, 95% CI 4.82-5.14; p < 0.001). At the UH, all prescriptions with aminoglycosides were gentamicin, while tobramycin accounted for 93% of all prescriptions with aminoglycosides at the DH. Conclusion: There is a potential for reduction in both antibiotic exposure and treatment length in these two neonatal units, and a systematic risk/observational algorithm of sepsis should be considered in both hospitals. We revealed no major differences between the UH and DH, but doses and choice of aminoglycosides varied significantly.
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Affiliation(s)
- Christian Magnus Thaulow
- Clinical Institute II, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Dag Berild
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Pharmacology, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Hege Salvesen Blix
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Drug Statistics, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Alesund, Norway
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20
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Pichler K, Assadian O, Berger A. Viral Respiratory Infections in the Neonatal Intensive Care Unit-A Review. Front Microbiol 2018; 9:2484. [PMID: 30405557 PMCID: PMC6202802 DOI: 10.3389/fmicb.2018.02484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 09/28/2018] [Indexed: 01/24/2023] Open
Abstract
Although infrequent, respiratory viral infections (RVIs) during birth hospitalization have a significant impact on short- and long-term morbidity in term and preterm neonates. RVI have been associated with increased length of hospital stay, severe disease course, unnecessary antimicrobial exposure and nosocomial outbreaks in the neonatal intensive care unit (NICU). Virus transmission has been described to occur via health care professionals, parents and other visitors. Most at risk are infants born prematurely, due to their immature immune system and the fact that they stay in the NICU for a considerable length of time. A prevalence of RVIs in the NICU in symptomatic infants of 6–30% has been described, although RVIs are most probably underdiagnosed, since testing for viral pathogens is not performed routinely in symptomatic patients in many NICUs. Additional challenges are the wide range of clinical presentation of RVIs, their similarity to bacterial infections and the unreliable detection methods prior to the era of molecular biology based technologies. In this review, current knowledge of early-life RVI in the NICU is discussed. Reviewed viral pathogens include human rhinovirus, respiratory syncytial virus and influenza virus, and discussed literature is restricted to reports based on modern molecular biology techniques. The review highlights therapeutic approaches and possible preventive strategies. Furthermore, short- and long-term consequences of RVIs in infants hospitalized in the NICU are discussed.
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Affiliation(s)
- Karin Pichler
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ojan Assadian
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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21
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Healthcare-Associated Viral Infections: Considerations for Nosocomial Transmission and Infection Control. HEALTHCARE-ASSOCIATED INFECTIONS IN CHILDREN 2018. [PMCID: PMC7121921 DOI: 10.1007/978-3-319-98122-2_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Nosocomial and healthcare-associated viral infections are major contributors to patient morbidity and mortality, prolonged hospitalization, and increased healthcare costs in all pediatric age groups. Healthcare workers are also at risk of acquiring nosocomial viral infections, affecting their own health, as well as facilitating spread of the infection to other patients, their family, and the community. Healthcare-associated viral infections may occur in a variety of healthcare settings, including clinics, emergency centers, urgent care centers, procedure suites, operating rooms, hospital wards, nurseries, and intensive care units. In addition, non-patient care areas, such as the cafeteria, waiting areas, and playrooms may also be a source of viral infections that can spread in the healthcare setting. These infections may be device-related or transmitted via blood products or organ donation and respiratory droplets, through food including human milk, person to person, or via air ducts, fomites, and surfaces. They most commonly involve the respiratory and gastrointestinal tracts; however, all organ systems may potentially be involved. Both DNA and RNA viruses, either common or exotic, may contribute to healthcare-associated viral infections. Advances in molecular viral diagnostics have enabled rapid detection and routine surveillance for viral infections and now allow early identification of viruses. Prompt identification allows timely containment measures to minimize transmission to other patients or healthcare workers and avoids hospital, community, and global outbreaks.
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22
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Brennan K, O'Leary BD, Mc Laughlin D, Breen EP, Connolly E, Ali N, O'Driscoll DN, Ozaki E, Mahony R, Mulfaul K, Ryan AM, Ni Chianain A, McHugh A, Molloy EJ, Hogan AE, Paran S, McAuliffe FM, Doyle SL. Type 1 IFN Induction by Cytosolic Nucleic Acid Is Intact in Neonatal Mononuclear Cells, Contrasting Starkly with Neonatal Hyporesponsiveness to TLR Ligation Due to Independence from Endosome-Mediated IRF3 Activation. THE JOURNAL OF IMMUNOLOGY 2018; 201:1131-1143. [PMID: 29980613 DOI: 10.4049/jimmunol.1700956] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 06/10/2018] [Indexed: 12/25/2022]
Abstract
Two million infants die each year from infectious diseases before they reach 12 mo; many of these diseases are vaccine preventable in older populations. Pattern recognition receptors represent the critical front-line defense against pathogens. Evidence suggests that the innate immune system does not fully develop until puberty, contributing to impaired response to infection and impaired vaccine responses in neonates, infants, and children. The activity of the pattern recognition receptor family of cytosolic nucleic acid (CNA) sensors in this pediatric population has not been reported. We show that in direct contrast to weak TLR-induced type I IFN in human cord blood mononuclear cells, cord blood mononuclear cells are capable of initiating a potent response to CNA, inducing both antiviral type I IFN and, unexpectedly, proinflammatory TNF-α. A deficiency in Rab11-GTPase endosome formation and consequent lack of IRF3 activation in neonatal monocytes is at least in part responsible for the marked disparity in TLR-induced IFN production between neonatal and adult monocytes. CNA receptors do not rely on endosome formation, and therefore, these responses remain intact in neonates. Heightened neonatal responses to CNA challenge are maintained in children up to 2 y of age and, in marked contrast to TLR4/9 agonists, result in IL-12p70 and IFN-γ generation. CNA sensors induce robust antiviral and proinflammatory pathways in neonates and children and possess great potential for use as immunostimulants or vaccine adjuvants for targeted neonatal and pediatric populations to promote cell-mediated immunity against invasive infectious disease.
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Affiliation(s)
- Kiva Brennan
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | | | - Danielle Mc Laughlin
- Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Eamon P Breen
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Emma Connolly
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Nusrat Ali
- National Maternity Hospital, Dublin 2, Ireland
| | | | - Ema Ozaki
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Rebecca Mahony
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Kelly Mulfaul
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Aoife M Ryan
- National Children's Research Centre, Crumlin, Dublin 12, Ireland
| | | | | | - Eleanor J Molloy
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland.,Women and Infants University Hospital, Dublin 8, Ireland
| | - Andrew E Hogan
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,Education and Research Centre and Conway Institute, St. Vincent's University Hospital, University College Dublin, Dublin 4, Ireland; and
| | - Sri Paran
- Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Fionnuala M McAuliffe
- National Maternity Hospital, Dublin 2, Ireland.,Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Sarah L Doyle
- National Children's Research Centre, Crumlin, Dublin 12, Ireland; .,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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Epidemiology of Sepsis-like Illness in Young Infants: Major Role of Enterovirus and Human Parechovirus. Pediatr Infect Dis J 2018; 37:113-118. [PMID: 28763426 DOI: 10.1097/inf.0000000000001718] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sepsis-like illness is a main cause for hospital admission in young infants. Our aim was to investigate incidence, epidemiology and clinical characteristics of enterovirus (EV) and human parechovirus (HPeV) infections in young infants with sepsis-like illness. METHODS This is a prospective observational cohort study in which infants younger than 90 days of age, presenting with sepsis-like symptoms in a secondary care children's hospital, underwent a full sepsis work-up. Clinical signs and infectious indices were recorded. EV or HPeV RNA was detected by polymerase chain reaction in plasma and/or cerebrospinal fluid (CSF). RESULTS Infants were diagnosed with EV, HPeV, fever of unknown origin or severe infection. EV and HPeV were detected in 132 of 353 (37%) and 52 of 353 (15%) of cases, respectively. EV and HPeV have distinct seasonability. Some differences in clinical signs and symptoms occurred between children with EV and HPeV infection but were of limited clinical value. CSF pleocytosis occurred in 44% of EV positive infants, and only in 13% of those with HPeV infection. CONCLUSIONS EV and HPeV infections are major causes of sepsis-like illness in infants < 90 days of age. Neither clinical characteristics nor laboratory indices were predictive for EV/HPeV infection. CSF pleocytosis occurs, but not in all patients. Testing for EV and HPeV in all young infants with sepsis-like illness is strongly advised.
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Horikoshi Y, Okazaki K, Miyokawa S, Kinoshita K, Higuchi H, Suwa J, Aizawa Y, Fukuoka K. Sibling visits and viral infection in the neonatal intensive care unit. Pediatr Int 2018; 60:153-156. [PMID: 29205682 DOI: 10.1111/ped.13470] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/14/2017] [Accepted: 11/30/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sibling visits to the neonatal intensive care unit (NICU) are a part of family-centered care, which is now being increasingly endorsed as a positive development in patient care. Sibling visits, however, pose a risk of viral infection, and hence many NICU in Japan impose strict limits on the practice. The aim of this study was therefore to assess whether sibling visits to the NICU are related to an increase in the nosocomial viral infection rate. METHODS This retrospective study was conducted between April 2012 and March 2017 at Tokyo Metropolitan Children's Medical Center in Japan. Sibling visits were implemented after screening for symptoms of viral illness. Symptomatic patients in the NICU were tested for common viruses on rapid antigen test and polymerase chain reaction. The number of sibling visits and the rate of nosocomial viral infections were examined on Spearman's correlation test. RESULTS The total number of sibling visits and rate of nosocomial viral infection in the NICU was 102 and 0.068 per 1,000 patient-days during the study period, respectively. The number of enterovirus, respiratory syncytial virus, human metapneumovirus, influenza virus A, and Herpes simplex virus infections was 3, 2, 1, 1, 1, and 1, respectively. No infections were identified after sibling visits. The number of sibling visits and the rate of nosocomial viral infections were not correlated (correlation coefficient, -0.1; P = 0.873). CONCLUSION Sibling visits to the NICU did not result in an increase in the nosocomial viral infection rate.
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Affiliation(s)
- Yuho Horikoshi
- Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Kaoru Okazaki
- Division of Neonatology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Shigeko Miyokawa
- Department of Nursing, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Kazue Kinoshita
- Division of Molecular Laboratory, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Hiroshi Higuchi
- Division of Microbiology, Department of Laboratory, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Junichi Suwa
- Department of Pharmacy, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Yuta Aizawa
- Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Kahoru Fukuoka
- Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
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Shui JE, Messina M, Hill-Ricciuti AC, Maykowski P, Leone T, Sahni R, Isler JR, Saiman L. Impact of respiratory viruses in the neonatal intensive care unit. J Perinatol 2018; 38:1556-1565. [PMID: 30158678 PMCID: PMC7100236 DOI: 10.1038/s41372-018-0197-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/05/2018] [Accepted: 07/30/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe the epidemiology and clinical impact of respiratory viruses in a neonatal intensive care unit (NICU). STUDY DESIGN We conducted a retrospective observational study of infants with respiratory viruses detected by multiplex reverse-transcriptase PCR from May 2012 to May 2017. The proportion of symptomatic vs. asymptomatic infants and associated morbidity were assessed. The association of infection prevention and control (IP&C) strategies and transmission was ascertained. RESULTS Respiratory viruses were detected in 83 infants representing 86 unique episodes during which infants remained asymptomatic in 15 (17%). Of the 71 symptomatic episodes, only 45% were associated with increased respiratory and/or nutritional support. Rhinovirus/enteroviruses were most common (69%) and involved nine of 12 transmission events. IP&C strategies including restricting visitors <12 years of age and screening exposed infants were associated with decreased transmission rates. CONCLUSIONS NICU patients can be asymptomatic carriers of respiratory viruses. Identification of such infants is important to prevent transmission in the NICU.
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Affiliation(s)
- Jessica E. Shui
- 0000000419368729grid.21729.3fDivision of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Maria Messina
- 0000000419368729grid.21729.3fDivision of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA ,0000 0000 8499 1112grid.413734.6Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY USA
| | - Alexandra C. Hill-Ricciuti
- 0000000419368729grid.21729.3fDivision of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Philip Maykowski
- 0000000419368729grid.21729.3fDivision of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA ,0000 0001 2168 186Xgrid.134563.6Present Address: University of Arizona College of Medicine–Phoenix, Phoenix, AZ USA
| | - Tina Leone
- 0000000419368729grid.21729.3fDivision of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Rakesh Sahni
- 0000000419368729grid.21729.3fDivision of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Joseph R. Isler
- 0000000419368729grid.21729.3fDivision of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Lisa Saiman
- Division of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA. .,Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY, USA.
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Sass L, Karlowicz MG. Healthcare-Associated Infections in the Neonate. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152335 DOI: 10.1016/b978-0-323-40181-4.00094-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Afonso EDP, Blot S. Effect of gestational age on the epidemiology of late-onset sepsis in neonatal intensive care units - a review. Expert Rev Anti Infect Ther 2017; 15:917-924. [DOI: 10.1080/14787210.2017.1379394] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Elsa Da Palma Afonso
- Neonatal Intensive Care Unit, Rosie Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Stijn Blot
- Department of Internal Medicine, Ghent University, Gent, Belgium
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Zacharie S, Vabret A, Guillois B, Dupont C, Brouard J. [Rhinovirus: Underestimated pathogens in patients during the neonatal period]. Arch Pediatr 2017; 24:825-832. [PMID: 28822736 PMCID: PMC7126818 DOI: 10.1016/j.arcped.2017.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 01/28/2017] [Accepted: 06/12/2017] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In recent years, developments in virological tools have led to the easy detection of rhinoviruses and enteroviruses (E/RV). Their detection is very frequent in cases of airway involvement in children and their demonstrated causality. But the morbidity of E/RV in the neonatal period is unknown due to lack of epidemiological data. The objective of this study was to evaluate the incidence and clinical characteristics of these infections in hospitalized neonates. MATERIALS AND METHODS We retrospectively analyzed the virology specimens of all neonates hospitalized at the Caen University Hospital between 2006 and 2011. Clinical characteristics were obtained from the charts. RESULTS During the study period, 4544 infants aged less than 28 days were hospitalized: 4159 in the neonatal ward and 385 in the pediatric ward. Among these, 711 virology specimens were available, 31 % of which identified at least one virus. An E/RV was identified in 87 patients (1.9 % of the neonates admitted during the study period): 52 in the pediatric ward (13.5 % of 385), and 35 in the neonatal ward (0.8 % of 4159). The mean gestational age was 39 weeks in the pediatric cohort and 35 weeks in the neonatal cohort. The main indication for virological analysis was persistent drowsiness (28 %), temperature above 38°C (25 %), an apparently life-threatening event (23 %), bradycardia (20.5 %), and pallor (20.5 %). Respiratory symptoms associated with E/RV infection were coryza (74 %), cough (35 %), hypoxemia (32 %), accessory muscle use, and recession (31 %). Digestive symptoms were poor feeding (59 %), regurgitation (38 %), abdominal distension (24 %), and projectile vomiting (17 %). Twenty-three percent of the patients required admission to the neonatal ICU or pediatric ICU. Respiratory treatments included oxygen (24 % of 87 patients), continuous positive airway pressure (11 %), and ventilation (5 %). Antibiotics were prescribed in 41 % of the patients (46), but only 10 % (9) had an identified concomitant bacterial infection. In the neonatal department, nosocomial acquisition was suspected in 50 % of E/RV infections. CONCLUSION E/RV infections have a significant morbidity in neonates, and nosocomial transmission of the virus is underestimated. We recommend that respiratory viruses, including E/RV, be tested for in any unexplained signs in a neonate. Better identification of viruses might shorten the duration of unnecessary antibiotics.
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Affiliation(s)
- S Zacharie
- Service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France; Service de pédiatrie, hôpital Sainte-Musse, centre hospitalier intercommunal Toulon-La-Seyne-sur-Mer, CS 31412, 83056 Toulon, France
| | - A Vabret
- Laboratoire de virologie, CHU de Caen, avenue Clemenceau, 14033 Caen, France; Groupe de recherche sur l'adaptation microbienne (GRAM2), Normandie université, Unicaen, Unirouen, 14000 Caen, France
| | - B Guillois
- Service de néonatologie, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - C Dupont
- Service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - J Brouard
- Service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France; Groupe de recherche sur l'adaptation microbienne (GRAM2), Normandie université, Unicaen, Unirouen, 14000 Caen, France.
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Cerone JB, Santos RP, Tristram D, Lamson DM, Stellrecht KA, St George K, Horgan MJ, Rios A. Incidence of respiratory viral infection in infants with respiratory symptoms evaluated for late-onset sepsis. J Perinatol 2017; 37:922-926. [PMID: 28518131 PMCID: PMC7100264 DOI: 10.1038/jp.2017.69] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/19/2017] [Accepted: 04/06/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the frequency, etiology and impact of respiratory viral infection (RVI) on infants evaluated for late-onset sepsis (LOS), defined as sepsis occurring >72 h of life, in the neonatal intensive care unit. STUDY DESIGN Prospective observational study conducted from 6 March 2014 to 3 May 2016 on infants evaluated for LOS. PCR viral panel performed on nasopharyngeal specimens among infants with clinical suspicion for RVI. Sequence analysis was performed to determine viral subtypes. Fisher's exact or χ2 tests were done to determine the impact of RVI. RESULTS During the 26-month study, there were 357 blood cultures obtained for LOS evaluations, 29 (8%) had a respiratory virus detected. Only 88 (25%) of infants evaluated for LOS also had clinical suspicion for a respiratory viral infection. RSV (14 of 29; 48%) was the predominant virus detected. Almost all infants (13 of 14; 93%) with RSV required increased respiratory support. Antimicrobial therapy was withheld or discontinued on most infants with a virus detected (18 of 29; 62%) and in the majority where there was no confirmed bacterial co-infection (18 of 20; 90%). CONCLUSION The incidence of RVI in infants being evaluated for LOS is about 8%. RVI should be considered in LOS evaluation to prevent unnecessary antibiotic therapy.
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Affiliation(s)
- J B Cerone
- Department of Pediatrics/Division of Neonatology, Albany Medical Center, Albany, NY, USA
| | - R P Santos
- Department of Pediatrics/Division of Infectious Disease at Albany Medical Center, Albany, NY, USA
| | - D Tristram
- Department of Pediatrics/Division of Infectious Disease at Albany Medical Center, Albany, NY, USA
| | - D M Lamson
- Laboratory of Viral Diseases at Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - K A Stellrecht
- Department of Pathology and Laboratory Medicine at Albany Medical Center, Albany, NY, USA
| | - K St George
- Laboratory of Viral Diseases at Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - M J Horgan
- Department of Pediatrics/Division of Neonatology, Albany Medical Center, Albany, NY, USA
| | - A Rios
- Department of Pediatrics/Division of Neonatology, Albany Medical Center, Albany, NY, USA
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Bonnet JF, Connelly TM, Vega GH, Rodriguez Herrera A. Human parechovirus sepsis induced coagulopathy in an infant. Enferm Infecc Microbiol Clin 2017; 36:143-144. [PMID: 28527677 DOI: 10.1016/j.eimc.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/05/2017] [Accepted: 04/08/2017] [Indexed: 11/25/2022]
Affiliation(s)
| | - Tara M Connelly
- Departament of Surgery, St. Luke's Hospital, Kilkenny, Irlanda
| | - Guillermo H Vega
- Department of Surgery, University Hospital Waterford, Waterford, Irlanda
| | - Alfonso Rodriguez Herrera
- Departmento de Biología Molecular e Ingeniería Bioquímica, Universidad Pablo Olavide, Sevilla, España
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Sasan MS, Nakhaei AA, Alborzi A, Ziyaeyan M. Interference of Vaccine Derived Polio Viruses with Diagnosis of Enteroviral Diseases in Neonatal Period. J Clin Diagn Res 2017; 10:SM01-SM02. [PMID: 28050469 DOI: 10.7860/jcdr/2016/16434.8813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 11/24/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Enteroviruses (EV) are a common cause of neonatal sepsis especially at the junction of summer and fall. AIM This study was planned to find the frequency of Enteroviral (EV) sepsis among neonates with clinical sepsis. MATERIALS AND METHODS This is a prospective descriptive study. Rectal and pharyngeal swab samples were taken from all neonates with clinical sepsis and a control group of neonates with simple jaundice. EV was confirmed by both cell culture and RT-PCR. Anti polio antiserum was used to differentiate Polioviruses from Non Polio EVs (NPEV). RESULTS We had 67 neonates with clinical sepsis and 31 cases of simple jaundice during 105 days. NPEVs were isolated from 2 cases (2.9%) of the sepsis arm and one neonate (3.2%) of the jaundice group. Polio virus was isolated from 16.2% and 15.3% of OPV recipients in the sepsis and jaundice group respectively. CONCLUSION Enteroviruses were not a common cause for neonatal sepsis in Nemazi hospital at the time of this study. OPV vaccinated neonates commonly pass the vaccine virus in their pharynx and stool which can be mistaken with NPEV.
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Affiliation(s)
- Mohammad Saeed Sasan
- Associate Professor, Department of Paediatrics, Mashhad University of Medical Sciences, Imam Reza Hospital , Mashhad, Iran
| | - Alireza Ataei Nakhaei
- Assistant Professor, Department of Paediatrics, Mashhad University of Medical Sciences, Imam Reza Hospital , Mashhad, Iran
| | - Abdolvahab Alborzi
- Professor, Department of Paediatrics, Shiraz University of Medical Sciences, Namazi General Hospital , Shiraz, Iran
| | - Mazyar Ziyaeyan
- Professor, Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Namazi General Hospital , Shiraz, Iran
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Kidszun A, Klein L, Winter J, Schmeh I, Gröndahl B, Gehring S, Knuf M, Weise K, Mildenberger E. Viral Infections in Neonates with Suspected Late-Onset Bacterial Sepsis-A Prospective Cohort Study. Am J Perinatol 2017; 34:1-7. [PMID: 27182999 PMCID: PMC7171717 DOI: 10.1055/s-0036-1584150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The aim of our study was to evaluate the occurrence of viral infections in infants with suspected late-onset bacterial sepsis in a neonatal intensive care unit. Methods In a prospective study, infants with suspected late-onset bacterial sepsis underwent viral testing alongside routine blood culture sampling. Using a multiplex reverse transcription-polymerase chain reaction enzyme-linked immunosorbent assay, nasopharyngeal aspirates were analyzed for adenovirus, respiratory syncytial virus (RSV), influenza virus A and B, H1N1 virus, parainfluenza virus 1 to 4, metapneumovirus, coronavirus, and picornavirus. Stools were examined for adenovirus, rotavirus, norovirus, and enterovirus. Results Between August 2010 and March 2014, data of 88 infants with 137 episodes of suspected late-onset bacterial sepsis were analyzed. Six infants were diagnosed with a respiratory viral infection (2 × RSV, 4 × picornavirus). Blood culture-proven bacterial sepsis was detected in 15 infants. Neither viral-bacterial coinfections nor polymerase chain reaction positive stool samples were found. Conclusion Respiratory viruses can be detected in a considerable number of neonates with suspected late-onset bacterial sepsis. In contrast, gastrointestinal viral or enterovirus infections appear uncommon in such cases.
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Affiliation(s)
- André Kidszun
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,Address for correspondence André Kidszun, MD Department of Neonatology, University Medical Center of the Johannes Gutenberg University MainzLangenbeckstrasse 1, 55131 MainzGermany
| | - Lena Klein
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Julia Winter
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Isabella Schmeh
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Britta Gröndahl
- Department of Pediatrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stephan Gehring
- Department of Pediatrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Markus Knuf
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,Children's Hospital, Dr. Horst Schmidt Klinik, Ludwig-Erhard-Strasse, Wiesbaden, Germany
| | - Kerstin Weise
- Institute for Virology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eva Mildenberger
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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de Jong EP, Holscher HC, Steggerda SJ, Van Klink JMM, van Elzakker EPM, Lopriore E, Walther FJ, Brus F. Cerebral imaging and neurodevelopmental outcome after entero- and human parechovirus sepsis in young infants. Eur J Pediatr 2017; 176:1595-1602. [PMID: 28891004 PMCID: PMC5682858 DOI: 10.1007/s00431-017-2981-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/26/2017] [Accepted: 08/02/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED Enterovirus (EV) and human parechovirus (HPeV) are major causes of sepsis-like illness in infants under 90 days of age and have been identified as neurotropic. Studies about acute and long-term neurodevelopment in infants with sepsis-like illness without the need for intensive care are few. This study investigates cerebral imaging and neurodevelopmental outcome following EV and HPeV infection in these infants. We studied infants under 90 days of age who were admitted to a medium care unit with proven EV- or HPeV-induced sepsis-like illness. In addition to standard care, we did a cerebral ultrasound and cerebral magnetic resonance imaging (MRI), as well as neurodevelopmental follow-up at 6 weeks and 6 months and Bayley Scale of Infant and Toddler Development 3rd edition (BSID-III) investigation at 1 year of age. Twenty-six infants, 22 with EV and 4 with HPeV, were analysed. No abnormalities were detected at cerebral imaging. At 1 year of age, two infants had a moderate delay on both the motor and cognitive scale, one on the cognitive scale only and three others on the gross motor scale only. CONCLUSION Although our study population, especially the number of HPeV positive infants is small, our study shows that these infants do not seem to develop severe neurodevelopmental delay and neurologic sequelae more often than the normal Dutch population. Follow-up to school age allows for more reliable assessments of developmental outcome and is recommended for further studies to better assess outcome. What is known: • Enterovirus and Human Parechovirus infections are a major cause of sepsis-like illness in young infants. • After intensive care treatment for EV or HPeV infection, white matter abnormalities and neurodevelopmental delay have been described. What is new: • In our 'medium care' population, no abnormalities at cerebral imaging after EV- or HPeV-induced sepsis-like illness have been found. • At 1 year of age, infants who had EV- or HPeV-induced sepsis-like illness do not seem to develop severe neurodevelopmental delay and neurologic sequelae more often than the normal population.
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Affiliation(s)
- Eveline P. de Jong
- Department of Pediatrics, Leiden University Medical Center, J-6, Albinusdreef 2, 2333 ZA Leiden, The Netherlands ,Department of Paediatrics, HAGA hospital, location Juliana Children’s Hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Herma C. Holscher
- Department of Radiology, HAGA hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Sylke J. Steggerda
- Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jeanine M. M. Van Klink
- Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Erika P. M. van Elzakker
- Department of Medical Microbiology, HAGA hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Enrico Lopriore
- Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Frans J. Walther
- Department of Medical Microbiology, HAGA hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Frank Brus
- Department of Paediatrics, HAGA hospital, location Juliana Children’s Hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
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Cabrerizo M, Díaz-Cerio M, Muñoz-Almagro C, Rabella N, Tarragó D, Romero MP, Pena MJ, Calvo C, Rey-Cao S, Moreno-Docón A, Martínez-Rienda I, Otero A, Trallero G. Molecular epidemiology of enterovirus and parechovirus infections according to patient age over a 4-year period in Spain. J Med Virol 2016; 89:435-442. [PMID: 27505281 DOI: 10.1002/jmv.24658] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 12/28/2022]
Abstract
The epidemiology and clinical association of enterovirus (EV) and parechovirus (HPeV) infections, as well as the type-distribution-according-to-age, were determined during a 4-year study period in Spain. During 2010-2013, a total of 21,832 clinical samples were screened for EV and the detection frequency was 6.5% (1,430). Of the total EV-negative samples, only 1,873 samples from 2011 to 2013 were available for HPeV testing. HPeV was detected in 42 (2%) of them. Positive samples were genotyped using PCR and sequencing. EV infections occurred in all age groups of patients: neonates (17%), children 28 days to 2 years (29%), children 2-14 years (40%), and adults (14%). Thirty-four different EV types were identified. HPeV infections were detected exclusively in infants <8 m (70% neonates, P < 0.05). All but one HPeV were HPeV-3. Differences in type frequency detection were found according to age and clinical manifestation. Coxsackievirus (CV)-B4 (61%), CV-B5 (83%), and HPeV-3 (64%) were more frequent in neonates than in older patients (P < 0.05). Echovirus (E)-3 (60%), E-18 (47%), E-25 (62%), CV-A6 (61%), CV-A16 (72%), and EV-71 (75%) were mainly detected in children 28 days to 2 years (P < 0.05), whereas, E-6 (79%), E-20 (88%), and E-30 (85%) were predominant in children >2 years and adults (P < 0.05). Clinically, meningitis was associated with EV (P < 0.01) whereas, encephalitis was more frequent in HPeV-infected patients. CV-B types were associated with myocarditis (90%; P < 0.05) and EV species A with hand-foot-mouth-disease/atypical exanthema (88%; P < 0.05). J. Med. Virol. 89:435-442, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- María Cabrerizo
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - María Díaz-Cerio
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - David Tarragó
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - María José Pena
- Hospital Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | | | - Almudena Otero
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Gloria Trallero
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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Lv XQ, Qian LH, Wu T, Yuan TM. Enterovirus infection in febrile neonates: A hospital-based prospective cohort study. J Paediatr Child Health 2016; 52:837-41. [PMID: 27149142 DOI: 10.1111/jpc.13193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 11/27/2022]
Abstract
AIM This study aims to investigate clinical characteristics and microbiological results and to assess the predictors for enterovirus infection in febrile neonates. METHODS A prospective cohort study was conducted on 334 febrile patients (age: 0.33-28 days) in 2011-2012 years. Enterovirus RNA was detected by reverse transcription polymerase chain reaction on faeces or cerebrospinal fluid (CSF). Clinical characteristics were compared, and non-conditional logistic regression analysis was performed to determine independent predictors for enterovirus infection. RESULTS There were 131 episodes of neonatal enterovirus infection (39.22%). Forty-eight (36.64%) developed respiratory symptoms, 69 (52.67%) had diarrhoea, 22 (16.79%) had poor feeding and 34 (25.95%) had rash. Eighteen (13.74%) had lower platelet counts, and CSF specimens were positive for enterovirus RNA in 44.27% (58/131) whose CSF revealed a mean white blood cell counts of 100.38 ± 147.97 cells/mm(3) (range: 2-668 cells/mm(3) ). The positivity of stool 38.92% (130/334) was significantly higher than that of CSF specimens 26.24% (58/221) for enterovirus RNA (P < 0.01). By logistic regression analysis, the following independently predicted enterovirus infection: abnormal CSF test (odds ratio (OR): 12.426, 95% confidence interval (CI): 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 Our data indicated that enteroviruses should be routinely considered in the differential diagnosis of febrile neonates. The factors, which may predict the risk of neonatal enterovirus infection, were abnormal CSF test, thrombocytopenia, duration of fever >3.25 (d), highest temperature >38.35 (°C) and negative bacterial culture.
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Affiliation(s)
- Xiao-Qing Lv
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The First People's Hospital of Yongkang, Jinhua, China
| | - Ling-He Qian
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tai Wu
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian-Ming Yuan
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Maitre NL, Williams JV. Human metapneumovirus in the preterm neonate: current perspectives. RESEARCH AND REPORTS IN NEONATOLOGY 2016; 6:41-49. [PMID: 27891060 PMCID: PMC5120728 DOI: 10.2147/rrn.s76270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Premature birth (<37 weeks gestation) occurs in ~11% of all births in the US. These infants are at risk of chronic lung disease and respiratory conditions, including bronchopulmonary dysplasia. Respiratory viruses are important causes of acute respiratory illness (ARI) in preterm infants, leading to rehospitalization, increased health care burden, and long-term morbidity. Human metapneumovirus (HMPV) is a paramyxovirus discovered in 2001 that is related to respiratory syncytial virus. Epidemiologic studies show that HMPV is a leading cause of ARI in children and adults worldwide. Prematurity is a major risk factor for severe HMPV disease, requiring hospitalization. Moreover, limited data suggest that HMPV infection during infancy is associated with asthma and recurrent wheezing, which are common long-term pulmonary complication of prematurity. HMPV causes nosocomial outbreaks of ARI in hospitals and long-term care facilities, although there are few studies of the prevalence of HMPV in neonatal intensive care unit populations. HMPV is a common and important virus in premature infants, and caregivers for preterm infants should consider this virus in patients with acute respiratory symptoms.
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Affiliation(s)
- Nathalie L Maitre
- Center for Perinatal Research, Department of Pediatrics, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - John V Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Morriss FH, Lindower JB, Bartlett HL, Atkins DL, Kim JO, Klein JM, Ford BA. Neonatal Enterovirus Infection: Case Series of Clinical Sepsis and Positive Cerebrospinal Fluid Polymerase Chain Reaction Test with Myocarditis and Cerebral White Matter Injury Complications. AJP Rep 2016; 6:e344-e351. [PMID: 27695644 PMCID: PMC5042705 DOI: 10.1055/s-0036-1593406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective We describe five neonates with enteroviral (EV) infection to demonstrate central nervous system (CNS) and cardiac complications and report successful treatment of myocarditis with immunoglobulin intravenous (IVIG) in two. Study Design Case series identified during three enteroviral seasons in one neonatal intensive care unit (NICU) by cerebral spinal fluid (CSF) reverse transcriptase polymerase chain reaction (PCR) testing for EV in neonates suspected to have sepsis, but with sterile bacterial cultures. Results Cases were identified in each of three sequential years in a NICU with 800 to 900 admissions/year. Two cases were likely acquired perinatally; all were symptomatic with lethargy and poor feeding by age 5 to 10 days. All had signs of sepsis and/or meningitis; one progressed to periventricular leukomalacia and encephalomalacia. Two recovered from myocarditis after treatment that included IVIG 3 to 5 g/kg. Conclusion Neonates who appear septic without bacterial etiology may have EV CNS infections that can be diagnosed rapidly by CSF PCR testing. Cases may be underdiagnosed in the early neonatal period if specific testing is not performed. Neonates with EV infection should be investigated for evidence of periventricular leukomalacia, screened for myocarditis, and considered for IVIG treatment.
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Affiliation(s)
- Frank H Morriss
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Julie B Lindower
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Dianne L Atkins
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Jean O Kim
- Department of Pediatrics, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Jonathan M Klein
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Bradley A Ford
- Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa; Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Abstract
PURPOSE OF REVIEW Although infection rates have modestly decreased in the neonatal intensive care unit (NICU) as a result of ongoing quality improvement measures, neonatal sepsis remains a frequent and devastating problem among hospitalized preterm neonates. Despite multiple attempts to address this unmet need, there have been minimal advances in clinical management, outcomes, and accuracy of diagnostic testing options over the last 3 decades. One strong contributor to a lack of medical progress is a variable case definition of disease. The inability to agree on a precise definition greatly reduces the likelihood of aligning findings from epidemiologists, clinicians, and researchers, which, in turn, severely hinders progress toward improving outcomes. RECENT FINDINGS Pediatric consensus definitions for sepsis are not accurate in term infants and are not appropriate for preterm infants. In contrast to the defined multistage criteria for other devastating diseases encountered in the NICU (e.g., bronchopulmonary dysplasia), there is significant variability in the criteria used by investigators to substantiate the diagnosis of neonatal sepsis. SUMMARY The lack of an accepted consensus definition for neonatal sepsis impedes our efforts toward improved diagnostic and prognostic options, and accurate outcomes information for this vulnerable population.
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Vezzani A, Fujinami RS, White HS, Preux PM, Blümcke I, Sander JW, Löscher W. Infections, inflammation and epilepsy. Acta Neuropathol 2016; 131:211-234. [PMID: 26423537 DOI: 10.1007/s00401-015-1481-5] [Citation(s) in RCA: 293] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 12/15/2022]
Abstract
Epilepsy is the tendency to have unprovoked epileptic seizures. Anything causing structural or functional derangement of brain physiology may lead to seizures, and different conditions may express themselves solely by recurrent seizures and thus be labelled "epilepsy." Worldwide, epilepsy is the most common serious neurological condition. The range of risk factors for the development of epilepsy varies with age and geographic location. Congenital, developmental and genetic conditions are mostly associated with the development of epilepsy in childhood, adolescence and early adulthood. Head trauma, infections of the central nervous system (CNS) and tumours may occur at any age and may lead to the development of epilepsy. Infections of the CNS are a major risk factor for epilepsy. The reported risk of unprovoked seizures in population-based cohorts of survivors of CNS infections from developed countries is between 6.8 and 8.3 %, and is much higher in resource-poor countries. In this review, the various viral, bacterial, fungal and parasitic infectious diseases of the CNS which result in seizures and epilepsy are discussed. The pathogenesis of epilepsy due to brain infections, as well as the role of experimental models to study mechanisms of epileptogenesis induced by infectious agents, is reviewed. The sterile (non-infectious) inflammatory response that occurs following brain insults is also discussed, as well as its overlap with inflammation due to infections, and the potential role in epileptogenesis. Furthermore, autoimmune encephalitis as a cause of seizures is reviewed. Potential strategies to prevent epilepsy resulting from brain infections and non-infectious inflammation are also considered.
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Affiliation(s)
- Annamaria Vezzani
- Department of Neuroscience, IRCCS-"Mario Negri" Institute for Pharmacological Research, Milan, Italy
| | - Robert S Fujinami
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - H Steve White
- Department of Pharmacology, University of Utah, Salt Lake City, UT, USA
| | - Pierre-Marie Preux
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
- Center of Epidemiology, Biostatistics, and Research Methodology, CHU Limoges, Limoges, France
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, WC1N £BG, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, 30559, Hannover, Germany.
- Center for Systems Neuroscience, Hannover, Germany.
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Abstract
Premature infants suffer significant respiratory morbidity during infancy with long-term negative consequences on health, quality of life, and health care costs. Enhanced susceptibility to a variety of infections and inflammation play a large role in early and prolonged lung disease following premature birth, although the mechanisms of susceptibility and immune dysregulation are active areas of research. This article reviews aspects of host-pathogen interactions and immune responses that are altered by preterm birth and that impact chronic respiratory morbidity in these children.
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Affiliation(s)
- Gloria S. Pryhuber
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 651, Rochester, NY 14642, USA,Department of Environmental Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA,Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 651, Rochester, NY 14642.
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Arnold M, Itzikowitz R, Young B, Machoki SM, Hsiao NY, Pillay K, Alexander A. Surgical manifestations of gastrointestinal cytomegalovirus infection in children: Clinical audit and literature review. J Pediatr Surg 2015; 50:1874-9. [PMID: 26265193 DOI: 10.1016/j.jpedsurg.2015.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/17/2015] [Accepted: 06/22/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Gastrointestinal sequelae of cytomegalovirus are rare, usually associated with significant immune compromise, and carry a high morbidity and mortality. Gastrointestinal disease frequently requires surgical intervention for diagnosis and management. AIM The aim of the study is to evaluate the incidence, presentation and management of gastrointestinal cytomegalovirus disease in a pediatric population. METHOD Between January 2003 and June 2011, a retrospective folder review was conducted of all symptomatic children with proven CMV disease, presenting to the surgical service. Eligible patients were identified using the surgical, histopathology and serology databases. RESULTS Thirty-eight patients (1.8/1000 surgical admissions) were identified with a median presenting age of 5months (range 3days-12years). Esophagitis (n=18) and small bowel disease (n=16) predominated, but CMV was seen throughout the gastrointestinal tract. Risk factors included HIV infection (n=21, 55%) and recent gastrointestinal surgery or infection (n=10, 26%). Characteristic multiple jejunoileal perforations were seen in six patients. Compared to upper GIT disease, intestinal involvement was associated with younger age and doubled mortality. In HIV-infected children, median CD4 (%) was lower in intestinal compared to upper gastrointestinal disease. Morbidities included anastomotic breakdowns (5), anastomotic strictures (3), relook laparotomies (10), resistant esophageal strictures (5) and prolonged parenteral nutrition (5). Anti-CMV drugs were given in 63%. Overall mortality was 32% (12/38) and was associated with lower GIT disease. CONCLUSION Invasive CMV gastrointestinal disease in our children was predominantly HIV-associated, or followed a major lower gastrointestinal inflammatory insult in infants younger than 6months. Successful therapy requires a high index of suspicion of active CMV disease to allow early implementation of CMV viral load control and aggressive treatment of the underlying immune impairment. Multiple surgical interventions are often required for both tissue diagnosis and management of acute and chronic complications. CMV-viral-load-tailored anti-CMV therapy is supported by recent literature.
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Affiliation(s)
- M Arnold
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - R Itzikowitz
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - B Young
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - S M Machoki
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - N Y Hsiao
- Division of Medical Virology, National Health Laboratory Service/University of Cape Town, Cape Town, South Africa
| | - K Pillay
- Department of Histopathology, NHLS, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - A Alexander
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Sullivan BA, Fairchild KD. Predictive monitoring for sepsis and necrotizing enterocolitis to prevent shock. Semin Fetal Neonatal Med 2015; 20:255-61. [PMID: 25823938 DOI: 10.1016/j.siny.2015.03.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite vigilant clinical assessment of infants in the neonatal intensive care unit (NICU), diagnosis of sepsis and necrotizing enterocolitis often does not occur until an infant has significant hemodynamic compromise. Predictive monitoring involves analysis of vital signs and other clinical data to identify infants at highest risk and to detect early-stage illness, leading to timelier treatment and improved outcomes. The first vital-sign predictive monitoring device developed for sepsis detection in babies in the NICU is the heart rate characteristics index (HeRO) monitor, which continuously analyzes the electrocardiogram signal for low heart rate variability and transient decelerations. Use of this monitor in very low birth weight infants (<1500 g) was shown in a large multicenter randomized clinical trial to significantly reduce mortality. The purpose of this review is (1) to summarize the physiologic changes in neonatal sepsis and progression to shock, (2) to review efforts toward risk stratification for sepsis shortly after birth based on demographic and physiologic scoring systems, (3) to describe development and implementation of heart rate characteristics monitoring and other important aspects of sepsis early warning systems, and (4) to provide an overview of current research analyzing multiple vital signs and other clinical variables in an attempt to develop even more effective predictive monitoring devices and systems.
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Affiliation(s)
- Brynne A Sullivan
- Neonatal/Perinatal Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Karen D Fairchild
- Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA, USA
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Human Parechovirus 3: The Most Common Viral Cause of Meningoencephalitis in Young Infants. Infect Dis Clin North Am 2015; 29:415-28. [PMID: 26188604 DOI: 10.1016/j.idc.2015.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Human parechoviruses (HPeVs) were initially classified as echoviruses. HPeVs occur worldwide, comprising up to 17 genotypes. HPeV1 and HPeV3 are most common. Clinical disease varies somewhat among genotypes. HPeV1 causes mostly gastrointestinal infections. HPeV3's prominence is due to its causing sepsis syndromes and central nervous system (CNS) infections in young infants. Currently, HPeV3 is the most common single cause of aseptic meningitis/meningoencephalitis in infants less than 90 days old in North America, usually with biannual summer-fall seasonality. HPeV3 CNS infections usually lack cerebrospinal fluid pleocytosis. Mortality and sequelae are uncommon, usually accompanying initially severe or neurologically complicated acute illnesses.
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Pammi M, Weisman LE. Late-onset sepsis in preterm infants: update on strategies for therapy and prevention. Expert Rev Anti Infect Ther 2015; 13:487-504. [DOI: 10.1586/14787210.2015.1008450] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Affiliation(s)
- Patrick J Oades
- Royal Devon & Exeter Foundation NHS Trust, Exeter, Devon, UK
| | - Shamez Ladhani
- Hepatitis and Blood Safety Department, Public Health England Colindale, Immunisation, London, UK
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Abstract
BACKGROUND Approximately 5-6% of all infective episodes in neonatal intensive care unit (NICU) are of viral origin. Previous studies suggest that human parechovirus (HPeV) infection presents most commonly in term infants, as a sepsis-like syndrome in which meningoencephalitis is prominent. Our aim was to study the infection rate and associated features of HPeV. METHODS Blood samples were taken from NICU babies older than 48 hours, who were being investigated for late onset sepsis. Clinical and laboratory data were collected at the time of the suspected sepsis episode. Samples were tested using universal primers and probe directed at the 5'-untranslated region of the HPeV genome by reverse transcriptase polymerase chain reaction (RT-PCR). Results were confirmed by electrophoresis and DNA sequencing. RESULTS HPeV was detected in 11 of 84 samples (13%). These infants had a mean [interquartile range (IQR)] gestational age of 28.9 (26.9-30.6) weeks and mean birth weight of 1.26 (SD = 0.72) kg. The median day of presentation was 16 (IQR: 11-27). These characteristics were similar to the infants without positive viral detection. Six infants presented with respiratory signs. One infant presented with signs of meningitis. Six of the 11 episodes of HPeV infection occurred during the winter months (December to February). No HPeV positive infants had abnormal findings on their 28-day cranial ultrasound examination. CONCLUSIONS We found an HPeV infection rate of 13% in infants being tested for late onset sepsis. HPeV should be considered as a possible cause of sepsis-like symptoms in preterm infants.
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Ronchi A, Michelow IC, Chapin KC, Bliss JM, Pugni L, Mosca F, Sánchez PJ. Viral respiratory tract infections in the neonatal intensive care unit: the VIRIoN-I study. J Pediatr 2014; 165:690-6. [PMID: 25027362 PMCID: PMC7094497 DOI: 10.1016/j.jpeds.2014.05.054] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/12/2014] [Accepted: 05/29/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine the frequency of respiratory viral infections among infants who were evaluated for late-onset sepsis in the neonatal intensive care units (NICUs) of Parkland Memorial Hospital, Dallas, Texas; and Women & Infants Hospital, Providence, Rhode Island. STUDY DESIGN Prospective cohort study conducted from January 15, 2012 to January 31, 2013. Infants in the NICU were enrolled if they were inborn, had never been discharged home, and were evaluated for sepsis (at >72 hours of age) and antibiotic therapy was initiated. Infants had a nasopharyngeal specimen collected for detection of respiratory viruses by multiplex polymerase chain reaction within 72 hours of the initiation of antibiotic therapy. Their medical records were reviewed for demographic, clinical, radiographic, and laboratory data until NICU discharge. RESULTS During the 13-month study, 8 of 100 infants, or 8 (6%) of the 135 sepsis evaluations, had a respiratory virus detected by polymerase chain reaction (2, enterovirus/rhinovirus; 2, rhinovirus; 2, coronaviruses; and 2, parainfluenza-3 virus). By bivariate analysis, the infants with viral detection were older (41 vs 11 days; P = .007), exposed to individuals with respiratory tract viral symptoms (37% vs 2%; P = .003), tested for respiratory viruses by provider (75% vs 11%; P < .001), and had lower total neutrophil counts (P = .02). In multivariate regression analysis, the best predictor of viral infection was the caregivers' clinical suspicion of viral infection (P = .006). CONCLUSIONS A total of 8% of infants, or 6% of all NICU sepsis evaluations, had a respiratory virus detected when evaluated for bacterial sepsis. These findings argue for more respiratory viral testing of infants with suspected sepsis using optimal molecular assays to establish accurate diagnoses, prevent transmission, and inform antibiotic stewardship efforts.
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Affiliation(s)
- Andrea Ronchi
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ian C Michelow
- Department of Pediatrics, Rhode Island Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | - Kimberle C Chapin
- Alpert Medical School of Brown University, Providence, RI; Department of Pathology and Medicine, Rhode Island Hospital, Providence, RI
| | - Joseph M Bliss
- Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women & Infants Hospital, Providence, RI
| | - Lorenza Pugni
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Pablo J Sánchez
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Department of Pediatrics, Center for Perinatal Research, Nationwide Children's Hospital - The Ohio State University, Columbus, OH.
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Soudée S, Schuffenecker I, Aberchih J, Josset L, Lina B, Baud O, Biran V. Infections néonatales à entérovirus en France en 2012. Arch Pediatr 2014; 21:984-9. [DOI: 10.1016/j.arcped.2014.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 06/12/2014] [Accepted: 06/24/2014] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE To review the accuracy of the pediatric consensus definition of sepsis in term neonates and to determine the definition of neonatal sepsis used. STUDY SELECTION The review focused primarily on pediatric literature relevant to the topic of interest. CONCLUSIONS Neonatal sepsis is variably defined based on a number of clinical and laboratory criteria that make the study of this common and devastating condition very difficult. Diagnostic challenges and uncertain disease epidemiology necessarily result from a variable definition of disease. In 2005, intensivists caring for children recognized that as new drugs became available, children would be increasingly studied and thus, pediatric-specific consensus definitions were needed. Pediatric sepsis criteria are not accurate for term neonates and have not been examined in preterm neonates for whom the developmental stage influences aberrations associated with host immune response. Thus, specific consensus definitions for both term and preterm neonates are needed. Such definitions are critical for the interpretation of observational studies, future training of scientists and practitioners, and implementation of clinical trials in neonates.
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