新生兒腸病毒感染

10.6666/ClinMed.201809_82(3).0092

盧清佑；鄭玫枝

腸病毒(enterovirus) ； 新生兒(neonate) ； 心肌炎(myocarditis) ； 垂直傳染(vertical transmission) ； 無菌性腦膜炎(aseptic meningitis) ； 肝臟壞死(hepatic necrosis)

臨床醫學月刊

82卷3期（2018 / 09 / 28）

509 - 516

繁體中文

腸病毒(enterovirus)感染是孩童時期常見的感染性疾病，一般常見症狀為手足口病或泡疹性咽峽炎，這些症狀在新生兒感染腸病毒時並不常見。國內腸病毒主要流行期為每年4到9月間，但是一整年都可能發現病例。5歲以下嬰幼兒是腸病毒併發重症的高危險族群，尤其是小於一歲的嬰兒與新生兒。依疾管局2018年迄今(8月初)之統計，已累計出現23例腸病毒併發重症病例，其中10例為新生兒且有7例死亡。過去腸病毒重症病例的孩童以感染腸病毒71型為多，但是今年的重症病例尤其是新生兒以感染伊科病毒11型為主。腸病毒之分類包含A、B、C、D等四型，包括小兒麻痺病毒(poliovirus)、克沙奇病毒(coxsackie virus)、伊科病毒(echovirus)，及其他各種腸病毒等，為最會造成人類疾病的病毒之一。腸病毒傳染力極強，主要透過接觸或食入病毒汙染物傳播，新生兒則可能透過母親垂直感染。大多數新生兒腸病毒感染沒有特別症狀，有些會出現發燒、躁動、食慾下降等非特異性症狀，且少數會表現出敗血症、心肌炎、肝壞死合併凝血功能異常、腦炎、肺炎合併呼吸衰竭等重症，須提高警覺。腸病毒感染的診斷，目前可以使用病毒分離(viral isolation)、血清學檢驗(serology)，或反轉錄酵素-聚合鏈鎖反應(reverse transcriptase-polymerase chain reaction, RT-PCR)等方法來確定診斷。絕大多數腸病毒感染的新生兒可自行恢復，僅需保守支持治療，對於新生兒感染腸病毒重症者則須通報疾管局且可考慮給予免疫球蛋白，但療效仍未確定。對於新生兒腸病毒感染，最重要的是預防及早期發現可能的重症病患，給予必要的支持性治療。

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