探讨新生儿重症监护病房(NICU)住院新生儿粪便肠道病毒(EV)类型及感染的临床特征。

选择2016年4月至2017年6月，于汕头大学医学院第一附属医院NICU住院治疗的85例新生儿为研究对象。根据诊断结果，将其分为EV感染组(n＝9)、无EV感染组(n＝76)。回顾性分析2组受试儿的临床病例资料。采集85例患儿的257份粪便标本，采用逆转录-聚合酶链反应(RT-PCR)法，检测粪便中EV。对EV呈阳性的PCR产物，采用一代测序法，进行EV血清型检测。采用χ²检验，对不同条件下新生儿EV感染率，以及2组新生儿临床表现及其实验室检查结果进行统计学比较。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》。

①本组NICU新生儿的EV感染率为10.6%(9/85)，其中柯萨奇病毒(COX)A6感染率为8.2%(7/85)，EV 71感染率为2.4%(2/85)。粪便标本EV检出率为5.1%(13/257)，首次于粪便中检出EV的患儿高峰日龄为1～7 d(66.7%，6/9)。②合并胎儿宫内感染、新生儿住院期内使用抗菌药物，母亲产前感染病史、罹患妊娠期糖尿病(GDM)及发生胎膜早破(PROM)新生儿的EV感染率分别为21.1%、18.2%、100.0%、30.8%、37.5%，均高于无相应病史新生儿的2.1%、2.4%、6.2%、6.9%、7.8%，并且差异均有统计学意义(P＝0.009，P＝0.030，P<0.001，χ²＝4.326、P＝0.038，χ²＝3.982、P＝0.046)。新生儿性别为男或女，新生儿为早产儿或足月儿，出生体重<2.50 kg或≥2.50 kg，分娩方式为经阴道或剖宫产术，喂养方式为母乳或配方奶等，新生儿EV感染率比较，差异均无统计学意义(P>0.05)。③EV感染新生儿消化道症状包括腹胀、消化道出血、呕吐、腹泻及肠穿孔等，其他症状还包括黄疸、发热、颅内感染、血小板减少等。EV感染组新生儿的黄疸、消化道症状及血小板减少发生率分别为100.0%、77.8%、22.2%，均高于无EV感染组的59.2%、22.4%、1.3%，并且差异均有统计学意义(χ²＝4.152、P＝0.042，χ²＝9.612、P＝0.002，P＝0.029)。④9例EV感染新生儿经治疗后，均治愈或好转出院，治疗2周症状消失后仍有3例(33.3%)粪便检测结果为EV阳性。

NICU新生儿粪便中可以检出EV。对于有宫内感染、住院期内使用抗菌药物，以及母亲有产前感染、GDM及PROM病史，并且伴不明原因感染症状的新生儿，应警惕新生儿EV感染可能。

To explore the enteroviral (EV) types in fecal samples of neonates hospitalized in neonatal intensive care units (NICU) and the clinical characteristics of neonatal EV infection.

The study included 85 neonates admitted to NICU of the First Affiliated Hospital of Shantou University Medical College from April 2016 to June 2017. According to diagnosis, they were divided into EV infection group (n=9) and non-EV infection group (n=76). The clinical case data of two groups of neonates were analyzed retrospectively. A total of 257 fecal samples of 85 neonates were collected and tested for EV in feces by reverse transcription-polymerase chain reaction (RT-PCR). For EV positive PCR products, EV serotype was detected by first-generation sequencing. Chi-square test was performed to compare the neonatal EV infection rates under different conditions, also compare the clinical manifestations and laboratory results between two groups. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

①The rate of EV infection among 85 cases neonates was 10.6% (9/85), with Coxsackie virus (COX) A6 infection rate of 8.2% (7/85) and EV 71 infection rate of 2.4% (2/85). The detection rate of EV in fecal samples was 5.1% (13/257), and the peak age of EV detected was 1-7 d age (66.7%, 6/9). ②The EV infection rates of neonates with fetal intrauterine infection, used antibacterials during hospitalization, maternal history of prenatal infection, gestational diabetes mellitus (GDM) and premature rupture of membranes (PROM) were 21.1%, 18.2%, 100.0%, 30.8%, 37.5%, respectively, which were higher than those of 2.1%, 2.4%, 6.2%, 6.9% and 7.8% of neonates without the corresponding history above mentioned, and the differences were statistically significant (P=0.009; P=0.030; P<0.001; χ²=4.326, P=0.038; χ²=3.982, P=0.046). There were no significant differences of EV infection rate between male and female neonates, between premature and full term infants, between birth weight <2.50 kg and ≥2.50 kg neonates, between vaginal delivery and cesarean section, and between breast feeding and formula feeding (P>0.05). ③The gastrointestinal symptoms of the neonates with EV infection included abdominal distension, gastrointestinal hemorrhage, vomiting, diarrhea and intestinal perforation etc., and other symptoms included jaundice, fever, intracranial infection and thrombocytopenia etc.. The incidence rates of neonatal jaundice, gastrointestinal symptoms and thrombopenia in EV infection group neonates were 100.0%, 77.8% and 22.2%, respectively, which were higher than those of 59.2%, 22.4% and 1.3% in non-EV infection group, and the differences were statistically significant (χ²=4.152, P=0.042; χ²=9.612, P=0.002; P=0.029). ④All the 9 neonates with EV infection were cured or improved after treatment, but among them, 3 (33.3%) neonates still had positive fecal EV result after 2 weeks of treatment and the transference cure.

EV can be detected in neonatal feces in NICU. For neonates with fetal intrauterine infection, usage of antibacterials during hospitalization, and maternal histories of prenatal infection, GDM and PROM, also with unexplained infectious symptoms, the possibility of neonatal EV infection should be vigilant.