Importancia de los enterovirus en la sepsis neonatal

Abstract

INTRODUCTION. Neonatal infections are one of the most prevalent pathologies and represent one of the main causes of mortality during this period of life. Most of the newborns who are admitted during the first month of life with suspected Bacterial Sepsis (BS) are diagnosed with infections caused by viruses. The viruses most involved in neonatal infection are enteroviruses (EV), with an incidence of 7 cases per 1000 newborns._x000D_ _x000D_ The objective of this study is to demonstrate the importance of EV as etiological agents in neonatal infection due to their differences in terms of clinical management and the therapeutic measures to be followed._x000D_ _x000D_ MATERIAL AND METHODS. The present work consists of a retrospective study with prospective data collection. A total of 332 NBs of gestational age> 34 SG attended in the Neonatology Unit of the Hospital de la Santa Creu i Sant Pau between January 2002 and December 2017 and with the initial diagnosis of Neonatal Sepsis (NS) were included._x000D_ _x000D_ RESULTS. The percentage of infections by EV was higher than that of BS with 34,6 and 32,5% respectively of the total of newborns studied. Newborns with EV infection present less maternal pathology except for hypertensive disease of pregnancy (p 0.001). Severe forms of the disease were rare (1.7%). 51.4% of the patients with EV infection underwent ATB treatment._x000D_ _x000D_ The detection of EV in CSF samples by RT-PCR showed high sensitivity, specificity, and high positive and negative predictive values in the diagnosis of EV infection._x000D_ _x000D_ The clinical evolution of patients with EV infection was favorable with resolution without sequelae in most cases. The case fatality rate in our children was 0.9%._x000D_ _x000D_ The EV types most frequently implicated in neonatal EV disease were E11, E6, E7 and CVB5._x000D_ _x000D_ A predictive model was obtained that allows calculating the risk probability of presenting BS or EV infection and correctly classifying 99% of the newborns with a precision of 95.6%. The variables that showed an association with EV infection were an older age in days of life at the time of suffering from the disease, higher scores in the Apgar test at 5 minutes, higher birth weight, an epidemic environment, and the alteration of the sensorium._x000D_ _x000D_ CONCLUSIONS. The inclusion of EV in the initial study of newborn with suspected neonatal sepsis is necessary because these infections present with a high prevalence in our study. Newborns with EV share clinical similarities with newborns with BS, but we found factors that allow us to differentiate EV infections from bacterial infections. The finding of these factors has made it possible to develop a predictive model that, together with the positivity of the rapid techniques for the detection of EV, allows us to differentiate these 2 infections and withdraw unnecessary antibiotic treatment.

Date of Award	2 Jul 2021
Original language	Spanish
Supervisor	Antonio Mur Sierra (Tutor)