Sanne Hoeks

Chapter 5 64 RESULTS Seventeen infants were included in this study. Eight infants were infected with EV, five with HPeV and the remaining four with HSV. The gestational age ranged from 26 1/7 to 40 6/7 weeks, the median age at disease onset was eight days after birth, ranging from 2 to 98 days (table 1). Two infants died. EV (n=8) HPeV (n=5) HSV (n=4) Gestational Age, weeks 38 (29-41) 39 (26-40) 40 (38-40) Birth weight, grams 3115 (730 - 3950) 3100 (960 - 3840) 3515 (2485 - 3960) Age at onset, days 7 (4-65) 8 (6-98) 10 (2-27) CSF, days after onset 1 (0-4) 0 (0-1) 1 (0-3) Blood, days after onset 3 (0-5) 2 (1-2) 1 (1-3) CSF cells, .10^6/L 106 (1-2120) 2 (0-4) 6 (3-68) CSF protein, g/L 1 (0.61-1.85) 0.75 (0.64-0.98) 0.73 (0.53-0.99) CRP, mg/L 11.5 (1-17) 11 (4-17) 12 (2-32) Leucocytes, 10^9/L 11.7 (6.5-14.6) 4.5 (2.3-7.6) 9.6 (3.8-27.2) Inotropic support 1 (12,5%) 1 (20%) 1 (25%) Seizures - Clinical - aEEG 1 (12,5%) 1 (12,5%) 1 (20%) 1 (20%) 3 (75%) 3 (75%) US abnormalities MRI abnormalities 6 (75%) 3 (37,5%) 4 (80%) 3 (60%) 4 (100%) 3 (75%) Adverse clinical outcome Severity groups - Normal - Uncertain - Severe 1 (12,5%) 7 (87,5%) 0 (0%) 1 (12,5%) 1 (20%) 1 (20%) 3 (60%) 1 (20%) 4 (100%) 0 (0%) 0 (0%) 4 (100%) TABLE 1. Characteristics of patients. Values are the median (range) and absolute numbers (percentages); EV = Enterovirus, HPeV = Human Parechovirus, HSV = Herpes Simplex Virus; CSF = Cerebral Spinal Fluid; CRP = C-Reactive Protein. Neuroimaging findings Cerebral MRI including diffusion weighted imaging (DWI) was performed 1-7 days (median 5 days) after disease onset if the cranial ultrasound (cUS) examination showed abnormalities or if clinical and/or subclinical seizures were present. In five infants (4 EV and 1 HPeV), cUS was normal and no seizures occurred. One infant with HSV died of severe pulmonary infection and MRI was not performed. One infant had normal MR imaging. MRI showed diffusion restriction in ten out of eleven infants with cystic evolution in three. Both in EV and HPeV infections, distribution of white matter injury was highly symmetrical and six out of eight infants had white