Introduction: Prematurity is an important risk factor for the fulminant form of neonatal enteroviral infection.
Methods: Between 2008 and 2014, four cases of enterovirus sepsis among preterm babies (twins 36w, twins 30w) were identified. All had laboratory confirmation of Coxsackie virus B infection by PCR identification of the virus. The clinical histories, medical management and pattern of death were observed retrospectively.
Results: Maternal fever was reported in both deliveries, disease onset was at 5 days (twins 36w) and 7 days (twins 30w) of life. Pulmonary bleeding was evident in three of the four cases. Twin1 (36w) presented with fever and aseptic meningitis followed by laboratory DIC. Deterioration was rapid at third day of illness due to pulmonary hemorrhage. Death occurred within hours as a result of progressive massive pulmonary bleeding episode. Twin 2 (36w) presented with mild aspetic meningitis and was discharged home after a few days. Twin1 (30w) presented with clinical sepsis, accompanied with hemodynamic and respiratory instability. Severe DIC was evident and deterioration due to massive pulmonary bleeding caused death within 24 hours. Twin 2 (30w) presented with clinical sepsis and multi-organ system involvement including laboratory and clinical DIC manifesting as pulmonary, GI and CNS bleeding. He ceased at twelve day of life.
Conclusion: This small series of preterm neonates with the diagnosis of Coxsackie B virus sepsis highlights the importance of pulmonary hemorrhage as a morbid complication of the disease. Based on the experience described here, the importance of early recognition and intervention is warranted.
