Norovirus infections in preterm infants: wide variety of clinical courses

BACKGROUND: Norovirus is an important cause of nonbacterial acute gastroenteritis in all ages. Atypical courses are described. Clinical symptoms are diarrhea, vomiting, nausea, abdominal cramps, fever and malaise. Apart from three recent short reports we describe for the first time an outbreak of norovirus in a tertiary Neonatal Intensive Care Unit. FINDINGS: The typical symptoms of norovirus infection are in part also seen in premature born infants but with a different pattern and a huge variety of clinical courses. Vomiting is not the main symptom of norovirus infection in premature infants but distended abdomen and other symptoms such as apnea, gastric remainders or sepsis like appearance. The course in premature born patients could be explained by an immunocompromised mice model. Extensive hygienic measures were necessary to control the outbreak without closing the Neonatal Intensive Care Unit. CONCLUSION: Norovirus infection in premature infants shows an impressive pattern of a wide variety of clinical courses. Only the consequent use of different hygienic pattern can lead to elimination of norovirus.