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.