Clinical manifestations of rotavirus infection in the neonatal intensive care unit

Objectives. This report describes clinical signs of rotavirus infection (RVI) among neonates admitted to a neonatal intensive care unit (NICU), compares these signs between term and preterm neonates and assesses the seasonal distribution of RVI in the NICU with that of the community. Methods. After an initial prevalence study of 28 days, a prospective longitudinal study in the NICU was conducted. During the next 48 months from December 1, 1991 to November 30, 1995, term and preterm NICU patients were evaluated daily for pre-defined deviations in their baseline gastrointestinal status. Fecal specimens of neonates who fulfilled the entry criteria were tested for rotavirus by a monoclonal antibody-based enzyme immunoassay and by immunoelectron microscopy. Demographic and outcome data for these neonates were collected. In addition data assessing RVI in the community were collected during this period. Results. The prevalence of RVI among NICU patients was 18.4%. Of 194 neonates included in the longitudinal study, 95 had RVI. Neonates with RVI differed from those without RVI with respect to frequent stooling (P = 0.0005), higher percentage of bloody mucoid stools (P = 0.003) and higher percentage of watery stools (P = 0.023). The odds of these three clinical outcomes were similar to2.5 times higher in neonates with RVI than in neonates without RVI. Among neonates included in the study advanced necrotizing enterocolitis occurred at the same rate (15%) among those with and without RVI. Comparisons between term and preterm neonates with RVI showed that frequent stooling (P = 0.003) and watery stools (P = 0.0001) occurred more often among term neonates, whereas bloody mucoid stools (P = 0.001), abdominal distention (P = 0.03) and intestinal dilatation (P = 0.016) were more common in preterm neonates. The seasonal distribution of RVI in NICU paralleled its distribution in the community. Conclusion. RVI appears prevalent in the NICU setting. An absence of watery stools in a neonate should not preclude consideration of RVI when evaluating gastrointestinal signs among neonates. The clinical spectrum of RVI differs in term and preterm infants.