Acute liver failure (ALF) in neonates is a severe condition with a high mortality rate up to 70%. It has been reported that human enterovirus (HEV) infections in newborns are related with myocarditis, meningoencephalitis and in rare cases, ALF with a fulminant course.

The present study used institutional clinical database to enrol cases of neonatal-onset ALF and their history and clinical data were obtained by medical record revision. In addition, infants with ALF underwent viral testing by nested real- time PCR (nRT-PCR).

The results revealed that five cases of neonatal ALF due to HEV among ten infants were identified in the 2004-2018 period. Out of these, mothers of three neonates reported an episode of mild fever and diarrhea during the last trimester of gestation, suggestive of fetal-maternal transmission. All of the children with HEV caused ALF were late preterm infants (32-36 weeks). Two infants out of five died as a result of ALF whereas the other three survived with full normalization of liver function. The causative agents were coxsackie B serotypes 3 in four neonates while in the fifth case had echovirus serotype 11.

Thus, it can be concluded that although human enterovirus (HEV) are a rare cause of ALF in neonates, HEV testing should be meticulously conducted in these cases for an appropriate diagnosis and treatment plan.

Source: Bersani I, Auriti C, Piersigilli F, et al. Neonatal acute liver failure due to enteroviruses: a 14 years single NICU experience. J Matern Fetal Neonatal Med. 2020;33(15):2576-2580.