Parechovirus infection in infants: Evidence‐based parental counselling for paediatricians

Abstract

Aim Human parechovirus (HPeV) is an increasingly recognised cause of severe illness and central nervous system infection in infants. Medium‐ to long‐term neurodevelopmental outcomes post‐HPeV infection remain unknown. This study aims to assess neurodevelopmental outcomes for children hospitalised as infants with HPeV infection in their second and third years of life. Methods This prospective cohort study followed children hospitalised with HPeV in Brisbane, Queensland during the 2017/2018 outbreak. Serial application of Ages and Stages Questionnaire (ASQ) was used to assess developmental progress in the second and third years of life. Data from clinical follow‐up, audiology and neuroradiology were included. Results In the second year of life, 63% (n = 29) of children showed some or significant concerns for developmental delay. This had largely been ameliorated by the third year of life when only 30% (n = 14) reported developmental concerns. Prematurity and apnoeas were associated with developmental concerns at 27–36 months of age. Communication was the most common domain of concern. Conclusions The majority of infants hospitalised with HPeV infection in 2017–2018 showed normalisation of developmental progress by 27–36 months of age. Further investigation into more subtle neurological impairments in later childhood is required. These results can help guide clinicians in counselling parents during the acute illness and in planning appropriate follow‐up.

Human parechovirus meningitis in children: state of the art

“…Most studies reported a higher incidence in males (56.4–91%) than in females [ 9 – 11 , 17 , 21 , 27 , 59 , 60 , 62 , 65 , 66 ]. Only two Korean studies reported a female prevalence (57.1-80%) [ 32 , 33 ].…”

“…Moreover, 15 reports evidenced the presence of seizures [ 1 , 10 , 11 , 21 , 26 , 28 , 45 , 50 , 58 , 62 , 65 – 68 , 70 ]. Their occurrence may vary from 3.1 to 65.2% [ 10 , 11 , 21 , 26 , 28 , 62 , 65 – 68 , 70 ].…”

“…Instrumental diagnostic exams were used as complementary and to investigate HPeV’s clinical complications and outcomes. Twenty-three publications analysed instrumental exams in patients affected by HPeV meningitis [ 1 , 10 , 12 , 25 , 26 , 28 , 45 , 48 – 50 , 56 – 58 , 62 , 65 – 68 , 71 – 73 , 77 , 78 ].…”

“…Hyperintensity in the T2/FLAIR was also a possible presentation of HPeV neuro-infection [ 28 ]. These findings were typically bilateral, either asymmetrical or symmetrical [ 50 , 58 , 65 ]. Other findings, such as unilateral lesions, low signal intensity on T2 and hyperintensity on T1 or just a leptomeningeal enhancement were also described [ 28 , 50 ].…”

Novel Human Parechovirus 3 Diversity, Recombination, and Clinical Impact Across 7 Years: An Australian Story

“…This included sociodemographic characteristics as well as markers of disease severity [ 9 ] (PICU admission, duration of hospitalization, apnea, seizures, brain magnetic resonance imaging [MRI] results, and developmental assessment after 6 months of age). A subgroup underwent prospective follow-up 1-year postinfection for formal developmental assessment (Ages and Stages Questionnaire) as part of another study [ 18 , 19 ], and these data were included where available.…”