Abstract
Background: The benefits of intravenous immunoglobulin (IVIG) therapy for severe neonatal enterovirus infections are still controversial. Object: To evaluate whether timing of IVIG administration might affect clinical outcomes of neonates with severe enteroviral infections. Study designs: We retrospectively analyzed 67 neonates with culture-confirmed severe enteroviral infection, defined as hepatitis with coagulopathy and thrombocytopenia. Clinical features, outcomes and the usage of IVIG therapy were collected and analyzed. IVIG administered within 3 days of illness onset was classified as early IVIG therapy. Results: Of the 67 cases, 38 (57%) were male, 27 (40%) were premature, 57 (85%) had disease onset within 7 days of life and all but 2 cases were caused by coxsackievirus B group. Ten infants (15%) had clinically evident myocarditis. 41 infants (61%) received IVIG therapy and 29 were early IVIG therapy. Fifteen infants (22%) eventually died, without IVIG therapy for 7 infants. The deceased had a significantly higher peak serum aspartate aminotransferase (AST) level than the survivors (3539 vs. 866. IU/L, p<. 0.01). The timing of IVIG therapy was highly correlated with the timing of peak AST level in patients with early IVIG therapy. Multiple logistic regression analysis showed that a higher nadir hemoglobin level (adjusted odds ratio 2.8, 95% confidence interval: 1.4-5.4), no concurrent myocarditis (42.6 [3.4-5289]) and early IVIG therapy (14.7 [1.3-163]) were independently associated with a favorable prognosis. Conclusions: In defined severe neonatal enterovirus infections, serum AST level correlated with the disease severity. Early IVIG therapy, if needed, may be beneficial for survival.
| Original language | English |
|---|---|
| Pages (from-to) | 92-96 |
| Number of pages | 5 |
| Journal | Journal of Clinical Virology |
| Volume | 64 |
| DOIs | |
| Publication status | Published - Mar 1 2015 |
| Externally published | Yes |
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Keywords
- Enterovirus
- Hepatitis
- Intravenous immunoglobulin
- Myocarditis
- Neonates
ASJC Scopus subject areas
- Virology
- Infectious Diseases
- Medicine(all)
Cite this
Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration. / Yen, Meng Hsiu; Huang, Yhu Chering; Chen, Min Chi; Liu, Ching Chuan; Chiu, Nan Chang; Lien, Reyin; Chang, Luan Yin; Chiu, Cheng Hsun; Tsao, Kuo Chien; Lin, Tzou Yien.
In: Journal of Clinical Virology, Vol. 64, 01.03.2015, p. 92-96.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration
AU - Yen, Meng Hsiu
AU - Huang, Yhu Chering
AU - Chen, Min Chi
AU - Liu, Ching Chuan
AU - Chiu, Nan Chang
AU - Lien, Reyin
AU - Chang, Luan Yin
AU - Chiu, Cheng Hsun
AU - Tsao, Kuo Chien
AU - Lin, Tzou Yien
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Background: The benefits of intravenous immunoglobulin (IVIG) therapy for severe neonatal enterovirus infections are still controversial. Object: To evaluate whether timing of IVIG administration might affect clinical outcomes of neonates with severe enteroviral infections. Study designs: We retrospectively analyzed 67 neonates with culture-confirmed severe enteroviral infection, defined as hepatitis with coagulopathy and thrombocytopenia. Clinical features, outcomes and the usage of IVIG therapy were collected and analyzed. IVIG administered within 3 days of illness onset was classified as early IVIG therapy. Results: Of the 67 cases, 38 (57%) were male, 27 (40%) were premature, 57 (85%) had disease onset within 7 days of life and all but 2 cases were caused by coxsackievirus B group. Ten infants (15%) had clinically evident myocarditis. 41 infants (61%) received IVIG therapy and 29 were early IVIG therapy. Fifteen infants (22%) eventually died, without IVIG therapy for 7 infants. The deceased had a significantly higher peak serum aspartate aminotransferase (AST) level than the survivors (3539 vs. 866. IU/L, p<. 0.01). The timing of IVIG therapy was highly correlated with the timing of peak AST level in patients with early IVIG therapy. Multiple logistic regression analysis showed that a higher nadir hemoglobin level (adjusted odds ratio 2.8, 95% confidence interval: 1.4-5.4), no concurrent myocarditis (42.6 [3.4-5289]) and early IVIG therapy (14.7 [1.3-163]) were independently associated with a favorable prognosis. Conclusions: In defined severe neonatal enterovirus infections, serum AST level correlated with the disease severity. Early IVIG therapy, if needed, may be beneficial for survival.
AB - Background: The benefits of intravenous immunoglobulin (IVIG) therapy for severe neonatal enterovirus infections are still controversial. Object: To evaluate whether timing of IVIG administration might affect clinical outcomes of neonates with severe enteroviral infections. Study designs: We retrospectively analyzed 67 neonates with culture-confirmed severe enteroviral infection, defined as hepatitis with coagulopathy and thrombocytopenia. Clinical features, outcomes and the usage of IVIG therapy were collected and analyzed. IVIG administered within 3 days of illness onset was classified as early IVIG therapy. Results: Of the 67 cases, 38 (57%) were male, 27 (40%) were premature, 57 (85%) had disease onset within 7 days of life and all but 2 cases were caused by coxsackievirus B group. Ten infants (15%) had clinically evident myocarditis. 41 infants (61%) received IVIG therapy and 29 were early IVIG therapy. Fifteen infants (22%) eventually died, without IVIG therapy for 7 infants. The deceased had a significantly higher peak serum aspartate aminotransferase (AST) level than the survivors (3539 vs. 866. IU/L, p<. 0.01). The timing of IVIG therapy was highly correlated with the timing of peak AST level in patients with early IVIG therapy. Multiple logistic regression analysis showed that a higher nadir hemoglobin level (adjusted odds ratio 2.8, 95% confidence interval: 1.4-5.4), no concurrent myocarditis (42.6 [3.4-5289]) and early IVIG therapy (14.7 [1.3-163]) were independently associated with a favorable prognosis. Conclusions: In defined severe neonatal enterovirus infections, serum AST level correlated with the disease severity. Early IVIG therapy, if needed, may be beneficial for survival.
KW - Enterovirus
KW - Hepatitis
KW - Intravenous immunoglobulin
KW - Myocarditis
KW - Neonates
UR - http://www.scopus.com/inward/record.url?scp=84923360351&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84923360351&partnerID=8YFLogxK
U2 - 10.1016/j.jcv.2015.01.013
DO - 10.1016/j.jcv.2015.01.013
M3 - Article
C2 - 25728086
AN - SCOPUS:84923360351
VL - 64
SP - 92
EP - 96
JO - Journal of Clinical Virology
JF - Journal of Clinical Virology
SN - 1386-6532
ER -