Clinical characteristics of viral intestinal infection in preterm and term neonates

Abstract

Objectives: The clinical presentation of the viral enteric pathogens in newborn infants has not been adequately examined. The aim of this study was to evaluate the clinical characteristics of viral intestinal infections in newborn infants. Methods: Clinical data of all term and preterm infants admitted to our tertiary neonatal intensive care unit from 1998 to 2007 with clinical signs of gastroenteritis (GE) or necrotizing enterocolitis (NEC) were retrospectively reviewed and compared between infants with different viral enteric pathogens in stool specimens. Results: In thirty-four infants with signs of GE or NEC, enteropathogenic viruses were found in stool specimens. Rotavirus was detected in 12 cases, of which 2 infants had NEC. Compared with infants with rotavirus or norovirus, infants with astrovirus more frequently suffered from NEC (p<0.05). In addition, an acute systemic inflammatory response was significantly more common in patients with astrovirus infection (astrovirus vs. rotavirus and astrovirus vs. norovirus p<0.01 and p<0.05, respectively). Of 8 children infected with norovirus, one infant had a systemic acute inflammatory response and NEC. Conclusions: This study demonstrates that in newborn infants, intestinal rotavirus, norovirus, and astrovirus infections may be associated with severe illness such as hemorrhagic enteritis resulting in bloody diarrhea or even NEC. We revised our manuscript "Clinical characteristics of viral intestinal infection in preterm and term neonates" according to the reviewers' comments. You may find our comments, additions and answers below (all changes made to the manuscript text are underlined).Reviewers' Comment 1: In the Abstract, under the Objectives paragraph it is stated that "The clinical presentation of viral intestinal infections in preterm and term neonates has not been adequately evaluated". This statement is not an objective in itself. It is an observation that could be included as background or as part of the introduction. The aims of the study should be better defined. Answer 1: According the reviewers' suggestions we revised the objectives in the abstract. Because of "200 words-limit in abstract" we revised the abstract, too (all changes made to the manuscript text are underlined).Reviewers' Comment 2: In the Results section (p.2, line 19) it should be mentioned that enteropathogenic viruses were found in 34 infants out of 220 (15.45%) infants with gastroenteritis (GE) and NEC (nectotizing enterocolitis). Answer 2: According the reviewers' suggestions we changed the sentence as recommended (Page 6, p.2).Reviewers' Comment 3: Among 112 infants with gastroenteritis, enteric viruses were detected in 22 patients (19.64%), and in 12 cases (11.11%) out of 108 infants with NEC. That means that approximately only in one case out of every 10 infants suffering of NEC was an enteric virus detected. The majority of cases with RV infection (10/12) were mild and self-limiting GE, but 2 preterm infants had signs of NEC. In this study, no enteric viruses were de...

The viral dsRNA analogue poly (I:C) induces necrotizing enterocolitis in neonatal mice

“…As the potential role of viral agents in the pathogenesis of NEC has only recently been recognized, we hypothesized that viral factors such as viral RNA could induce NEC in a neonate mouse model. Exclusively RNA viruses such as rota-, astro-, toro-, and norovirus have been associated with NEC (5,(8)(9)(10)(11)23). Among those, rotavirus, a dsRNA virus, is a well-known highly prevalent cause for severe diarrhea in infants and young children (24).…”

Norovirus

“…Of 8 neonates (mean gestational age, 28 weeks) who developed norovirus-associated necrotizing enterocolitis at the age of 15 to 38 days, 2 died (49). A retrospective study found that 1 of 8 neonates with a mean gestational age of 29 weeks and with norovirus infection occurring at a postnatal age ranging from 8 to 92 days developed necrotizing enterocolitis (50). Of the other 7 neonates, all had symptoms of gastroenteritis with diarrhea and abdominal distention, 4 had apnea, 3 vomited, and 3 had blood in their stool.…”

“…Two doses of each vaccine were administered intranasally 3 weeks apart. Participants were then challenged orally with a dose of Norwalk virus (48 RT-PCR units) that was ϳ10-fold higher than the ID 50 . The vaccine was well tolerated, and 70% of 47 vaccine recipients had a Ն4-fold increase in the serum concentration of Norwalk virus-specific IgA antibody levels, as measured by an enzyme immunoassay.…”

Necrotizing Enterocolitis in a Term Neonate Following Intravenous Immunoglobulin Therapy

“…Doppler studies of mesenteric arterial flows were not done in this baby but other workers have demonstrated that altered mesenteric artery flow due to microthrombi correlates with development of NEC and this could have happened because IVIgG is known to increase viscosity of blood due to hyperproteinemia [9]. PCR in stool and ascitic fluid were negative for astrovirus, norovirus and CMV, all of which are known to be associated with neonatal NEC [10].…”