In this issue of the Annals, Verboon-Maciolek and coworkers show that human parechovirus (HPeV), specifically HPeV3, is an important cause of neonatal viral encephalitis.1 The six serotypes of HPeVs that are included in the genus Parechovirus are small single-stranded (ss) RNA viruses belonging to the family Picornaviridae.2 , 3 These viruses bear many similarities with another and better-known Picornaviridae genus, Enterovirus (EV). Indeed, the genus Parechovirus began with the reclassification of echovirus 21 and 22 as HPeV1 and HPeV2 because of molecular and genetic differences from the remainder of EV. These differences are important because they explain, in part, why the usual polymerase chain reaction (PCR) testing for EV does not detect HPeV. Thus encephalitic infection by HPeV3 has been overlooked in the past, one important point of the current article. (Neonatal encephalitis by other HPeV subtypes is extremely rare and not discussed further.) The encephalitis caused by HPeV3 infection as well as by EV is associated with neonatal seizures and with apparent cerebral white matter injury.1 , 4 The current report has important implications concerning the etiology of neonatal viral encephalitis, the differential diagnosis of neonatal seizures, and the pathology and pathophysiology of the white matter injury.Concerning the etiology of neonatal encephalitis, the findings of Verboon-Maciolek et al.1 indicate that HPeV3 is a major cause. Indeed during the period of their study, neonatal encephalitis due to HPeV3 was three times more common than that due to EV and accounted for 64% of all encephalitic cases admitted to their NICU. Of the major viral infections of the developing nervous system (Table), i.e., rubella, cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster, human immunodeficiency virus (HIV), lymphocytic choriomeningitis virus, and EV/HPeV, most are acquired in utero and symptomatic neonatal encephalitis is uncommon (Table).5 HSV and EV/HPeV are associated most consistently with neonatal rather than fetal encephalitis.5 HSV encephalitis exhibits diffuse gray and white matter changes and is discussed elsewhere.5 Neonatal encephalitis caused by EV/HPeV has a distinctive clinical presentation and an apparent predilection for the white matter, as discussed next.Concerning the clinical features of EV/HPeV encephalitis, the usual presentation is fever, rash, irritability and seizures.6 -8 Diarrhea is a common accompaniment, and occurrence in summer and fall, characteristic. Seizures are more common in HPeV3 encephalitis (90%)1 than in EV encephalitis (40%)8 and require more than one anticonvulsant drug for control in most cases. Importantly, the routine CSF examination is normal in 90% of HPeV3 cases and in the majority of EV cases, as well, and therefore on initial clinical evaluation, encephalitis could be easily overlooked. Thus, PCR analysis that includes analysis for HPeV3 as well as EV (and HSV) in CSF and blood is important in the assessment of newborns with