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Remember the heart: neonatal myocarditis
  1. Khuen Foong Ng1,
  2. Jack Gibb2,
  3. Siske Struik3,
  4. Peter J Davis4,
  5. Peter Muir5,
  6. Chris Gillett6,
  7. Sivakumar Oruganti7,
  8. Marion Roderick1
  9. Neonatal Enteroviral Myocarditis Consortium
    1. 1 Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, UK
    2. 2 Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
    3. 3 Paediatric Infectious Diseases and Immunology, Noah's Ark Children's Hospital for Wales, Cardiff, UK
    4. 4 Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK
    5. 5 South West Regional Laboratory, UK Health Security Agency, Bristol, UK
    6. 6 Paediatric Cardiology, Noah's Ark Children's Hospital for Wales, Cardiff, UK
    7. 7 Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
    1. Correspondence to Dr Khuen Foong Ng, Pediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, BS2 8BJ, UK; khuenfoong.ng{at}nhs.net

    https://doi.org/10.1136/archdischild-2023-325316

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      The presentation of a neonate with poor feeding and respiratory distress is a common paediatric scenario. While acute myocarditis is an uncommon cause of this presentation, rapid recognition and intensive care support gives these infants the best possible chance of survival. During September–December 2022, eight infants were admitted to paediatric intensive care units (PICUs) in the Southwest of England and South Wales with neonatal enterovirus myocarditis (NEM).

      All eight neonates presented acutely in extremis with reduced feeding, tachypnoea and cardiogenic shock. Two initially had enteroviral meningitis. Seven had laboratory features of haemophagocytic lymphohistiocytosis (HLH) (table 1). Enterovirus was detected in all patients. They had severe left ventricular dysfunction on initial echocardiography. Electrocardiography demonstrated widespread Q waves, low voltage R waves and ST segment abnormalities. Due to the severity of their condition, clinical trajectory and evidence of inflammation, immunomodulation and antiviral therapy (where possible) were commenced. Extracorporeal membrane oxygenation was considered in five patients, but it was deemed inappropriate because of poor …

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      Footnotes

      • Collaborators Neonatal Enteroviral Myocarditis Consortium: Peter J Davis, Peter Muir, Chris Gillett, Sivakumar Oruganti and Marion Roderick.

      • Contributors MR conceptualised the work. KFN designed the data collection form. KFN and JG led the data curation process. KFN, JG, PM, CG, SO and SS collected, verified and validated the data. KFN, JG, PM, PJD, SS and MR analysed and interpreted the data. JG and KFN drafted the first manuscript. All the authors reviewed, edited and critically revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; internally peer reviewed.