Neonatal acute liver failure (ALF) presents as a severe condition with a mortality rate as high as 70%. Newborns, if contact Human enterovirus (HEV) infections can have serious diseases like myocarditis, meningoencephalitis and more rarely, ALF with a fulminant course. 

A study identifies the cases of neonatal-onset ALF utilizing the institutional clinical database. Medical records were utilized to collect the history and clinical data of infants with HEV infection. Nested real-time PCR (nRT-PCR) was done for viral testing.

The results demonstrated that-

• Among ten infants with neonatal-onset ALF, five were due to HEV. 
• 3 of 5 mothers experienced an episode of mild fever and diarrhoea during the last trimester of gestation, suggesting fetal-maternal transmission. 
• All infants were late preterm (32-36 weeks). 
• Two infants died of ALF, while the other three survived with full normalization of liver function. 
• Four infants showed causing agents to be coxsackie B serotypes 3 (n = 1), 4 (n = 1) and 5 (n = 2) 
• The fifth case demonstrated echovirus serotype 11 as the causative agent.

Thus Human enterovirus (HEV) can be rendered as a rare but relevant cause of ALF in neonates and HEV testing is advisable in cases of neonatal ALF for diagnostic and management purposes.

Source: Bersani I, Auriti C, Piersigilli F, Dotta A, Diomedi-Camassei F, Di Pede A, Buttinelli G, Danhaive O. Neonatal acute liver failure due to enteroviruses: a 14 years single NICU experience. J Matern Fetal Neonatal Med. 2020;33(15):2576-2580.