Abstract: Background Hepatic necrosis with coagulopathy (HNC) is one of the serious complications of neonatal enterovirus infection. Early recognition is difficult, the disease progresses rapidly, and the mortality rate is high.Objective To study the clinical features of neonatal enterovirus infections with HNC, and to provide a basis for early identification and active treatment of HNC.DesignA retrospective nested case-control study.Methods The neonates with enterovirus infection admitted to Children's Hospital of Fudan University from January 2010 to January 2020 were included. The clinical characteristics, treatment and prognosis were collected, and the clinical characteristics of the HNC group and the non-HNC group were compared,as well as the risk factors for the occurrence of HNC.Main outcome measures Incidence,mortality and risk factors of HNC.Results A total of 108 cases of neonatal enterovirus infections were included with 32 cases (29.6%) in the HNC group and 76 cases in the non-HNC group. The gestational age, birth weight, and age of onset of the HNC group were significantly lower than those of the non-HNC group (P＜0.05). The maternal history of illness in the HNC group was significantly higher than that in the non-HNC group (P＜0.001). The mortality of neonates in the HNC group was significantly higher than that of the non-HNC group (46.9% vs 2.6%, P＜0.001). Multivariate logistic regression analysis showed that the maternal history of illness (OR=7.04, 95%CI: 2.20-22.55) and age of onset (OR=0.903, 95%CI: 0.819-0.996) were independently associated with HNC. The peak AST level in the HNC death subgroup was significantly higher than that in the survival subgroup(P=0.016). The peak INR level in the HNC death subgroup was significantly higher than that in the survival subgroup(P=0.009). The proportion of complicated myocarditis in the HNC death subgroup was significantly higher than that in the survival subgroup (P=0.008). The use rate of plasma, albumin, mechanical ventilation and vasoactive drugs in the HNC death subgroup increased significantly.Among the 17 surviving children with HNC, 11 were followed up without a poor long-term prognosis such as dysaudia, blindness, epilepsy cerebral palsy and mental retardation.Conclusion In neonates with enterovirus infection, the incidence of HNC is higher. The maternal history of illness and earlier age of onset are significantly related to HNC. The mortality rate of neonates with HNC is high, especially those with severe hepatic necrosis and concurrent myocarditis, but the survival group usually has a good prognosis.

Key words: Enterovirus infection, Clinical feature, Hepatic necrosis, Neonate, Prognosis