# Differences in Clinical Manifestations of Human Parechovirus–Related Meningitis in Neonates After the COVID‐19 Pandemic: A Single‐Center Exploratory Study

## TL;DR

This study explores how neonatal meningitis caused by human parechovirus presented differently after the COVID-19 pandemic, with prolonged fever and respiratory issues.

## Contribution

The study identifies potential shifts in clinical features of neonatal HPeV meningitis post-pandemic, including prolonged fever and respiratory symptoms.

## Key findings

- Fever was the primary symptom, with prolonged duration (mean 4.3 days) despite no leukocytosis or pleocytosis.
- Half of the neonates required high-flow nasal cannula support due to respiratory symptoms.
- Hyponatremia occurred in two neonates without neurological issues, a less commonly reported finding.

## Abstract

Human parechovirus (HPeV) is one of the major causes of viral meningitis in neonates. Following the COVID‐19 pandemic, a resurgence of HPeV infections was reported worldwide. This exploratory case series is aimed at describing the symptoms of neonatal HPeV meningitis occurring after the lifting of large‐scale quarantine measures.

We retrospectively reviewed eight neonates admitted between June 1, 2023, and September 30, 2023, with fever and HPeV detected in cerebrospinal fluid (CSF) using the FilmArray Meningitis/Encephalitis Panel. Demographic variables, clinical presentation, laboratory data, respiratory support requirements, and treatment courses were analyzed.

Fever was the primary presenting symptom. Despite the absence of leukocytosis or pleocytosis, fever duration was prolonged (mean 4.3 days). Four patients (50%) exhibited respiratory symptoms requiring high‐flow nasal cannula support. Hyponatremia occurred in two neonates without neurological manifestations—an observation not commonly described in previous cohorts. No patients required invasive ventilation.

This small, single‐center series suggests possible variations in neonatal HPeV presentation after the COVID‐19 pandemic; however, findings are preliminary and hypothesis‐generating. Larger multicenter studies with subtype analysis and long‐term neurodevelopmental follow‐up are essential.