The Development of Enterovirus Sepsis Syndrome in a Preterm Neonate: A Case Report.

Abstract

Background: Enterovirus (EV) infections are common in pregnant patients and neonates. However, peripartum EV infections are significantly underdiagnosed. Infants with EV infection may be asymptomatic, present with a non-specific febrile illness, or develop life-threatening disease.

Clinical findings: This infant had an unremarkable clinical course for a preterm neonate, until a rising direct bilirubin, elevated liver enzymes, coagulopathy, and thrombocytopenia were identified by the neonatology team. The infant was then transferred to the level IV NICU with concern for liver failure of unknown origin.

Primary diagnosis: This case describes the development of EV sepsis syndrome in a preterm neonate, including EV sepsis, hepatitis, meningitis, and myocarditis.

Interventions: The neonate received intravenous immunoglobulin as supportive care. An emergency Investigational New Drug Application was submitted to the FDA Center for Drug Evaluation and Research Division of Antivirals, and the experimental antiviral pocapavir was authorized for compassionate use.

Outcomes: The neonate was discharged home from the NICU on day of life 75. She improved clinically by the end of treatment, with no critical sequelae of EV sepsis syndrome observed and no identifiable adverse effects of pocapavir noted. Regarding follow-up, the specialists continue to be pleased with her progress.

Practice recommendations: Enterovirus infections are ubiquitous in neonates and can cause life-threatening disease. NICU clinicians must maintain a high index of suspicion for EV infection. Lastly, the collaboration and creativity of the interdisciplinary team is vital, including the potential investigation of experimental treatments that could possibly help in extreme circumstances of acute illness.