Pediatric emergency medicine trisk 2590 2590

some neonates have been reported to have a very low glucose level. Enteroviral
PCR sent from CSF samples is diagnostic. PCR can also be sent from serum,
urine, nasopharyngeal, and stool samples. Blood cultures are negative,
differentiating enteroviral from bacterial sepsis. It should be noted that 3% of
neonates evaluated for suspected bacterial sepsis will have an enteroviral
infection. Although viral cultures are the traditional methods of diagnosis, it may
take longer to obtain results. PCR is sensitive and is a faster test. Liver function
tests may reveal an acute elevation of transaminases and there may be
coagulopathy. CXR may reveal infiltrates or cardiomegaly with pulmonary
edema. Echocardiography is needed for cases with arrhythmia or signs of low
cardiac output. Enteroviral disease should be differentiated from other causes of
neonatal sepsis, acute fulminant hepatitis, and myocarditis. In mild cases,
spontaneous recovery is the rule. In severe cases, mortality rate can reach 50%
for those with myocarditis and 31% for those with fulminant hepatic failure and
coagulopathy. Sudden infant death syndrome has also been reported with
enteroviral infections. Management of the newborn is directed toward fluid
resuscitation, maintaining adequate blood pressure with pressors if needed, and
supportive care. Neonates should be admitted to an intensive care unit and
contact precautions instituted. High-dose intravenous immunoglobulin may be
administered once diagnosis has been determined.

Special Considerations
Delivery in the ED
Pediatric emergency physicians may find themselves in a position where they
must attend a precipitous delivery of a newborn. The following section reviews
the key points of delivering a fetus in a cephalic position.
KEY POINTS