A 4-day-old term infant with a low EOS risk score originally presented to the ED with six hours of lethargy and poor feeding. Initial work-up was demonstrated acute liver failure (PT/INR 18.5, ALT>90, AST>300), hypoglycemia, hyperferritinemia (ferritin >44,000), severe thrombocytopenia, and hypoxia concerning for enteroviral sepsis. Her hospitalization was complicated by hyperinsulinemia, hypoxic respiratory failure, severe pulmonary hypertension, and decreased systolic biventricular function (concerning for myocarditis). The patient required mechanical ventilation as well as vasoactive support with epinephrine and milrinone.
Management of her severe enteroviral sepsis was primarily supportive; however, the patient was initially treated with 2 g IVIG. Existing literature demonstrates some level of evidence in favor of using IVIG for the treatment of severe enterovirus infection. Despite her complications, the patient showed remarkable improvement after treatment with IVIG. At time of discharge, she was tolerating enteral feeds and was weaned off both heart failure therapies and sildenafil. Her echocardiogram showed mildly diminished systolic function and mild mitral valve regurgitation.
This case presentation will further contribute to the literature addressing the utility IVIG use in neonates with enterovirus infection. We aim to complete a comprehensive literature review and identify the most recent evidence and consensus on guidelines about the use of IVIG in the fetus and neonate.