Neonatal enterovirus infection can range from asymptomatic infection to overwhelming sepsis and death. Neonates can acquire infection via vertical transmission, during delivery, or by horizontal transmission from siblings or other family members.

While most cases are asymptomatic, symptoms may include neonatal fever or hypothermia, poor feeding, low tone, lethargy, jaundice, rash, respiratory distress, and seizures as well as symptoms of sepsis. Echovirus and coxsackie B are the most common enteroviral causes of neonatal enteroviral sepsis.

Severe disease may also include hepatic necrosis with disseminated intravascular coagulation (DIC), meningoencephalitis, and myocarditis. In cases of myocarditis, arrythmias, poor perfusion, hypersensitivity myocarditis, and generalized edema and shock may be seen. The disseminated form with hepatic failure and myocarditis is often fatal. Case fatality rates of 0%-42% have been reported. In one series of 146 neonatal infections, 61 had aseptic meningitis, 43 had a nonspecific febrile illness, and 42 had hepatic necrosis with coagulopathy.

Related topic: enteroviral infection