目的 分析新生儿肠道病毒感染的临床特征，探讨抗生素管理改进方案对减少肠道病毒感染患儿抗生素使用的影响。方法 回顾性分析2019年1月至2023年12月新生儿科收治住院的诊断为肠道病毒感染新生儿的临床资料；根据是否合并器官衰竭分为一般感染组和重症感染组，比较两组间患儿临床特征差异。结果 共纳入肠道病毒感染新生儿153例，主要集中在5~7月份；其中男94例、女59例；出生胎龄39.3（38.1~40.3）周，出生体重3 200.0（2 950.0~3 450.0）g；早期新生儿35例；发病日龄15.0（8.0~23.0）天。所有患儿中首发症状为发热146例，病程中出现发热152例，发热病程1.8（1.5~2.4）天。入院中位白细胞计数为5.0（3.5~7.2）×10⁹/L，中位C反应蛋白水平2.4（0.5~7.3）mg/L；中位降钙素原水平0.2（0.1~0.3）ng/mL。一般感染组146例患儿均好转出院。7例重症感染患儿合并出血肝炎综合征4例，死亡2例；合并心肌炎3例，死亡2例。与一般感染组相比，肠道病毒重症感染组胎龄较小，病程中出现纳差反应差比例较高，血红蛋白、血小板计数较低，乳酸、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、肌酸激酶、肌酸激酶MB型同工酶均较高，差异有统计学意义（P<0.05）。肠道病毒PCR阳性标本进行测序分型共检出9种血清型，其中以柯萨奇病毒B3、埃可病毒12及埃可病毒30型最多见，共占62.7%。实施抗生素管理质量改进后，肠道病毒感染新生儿抗生素使用率较低，抗生素使用时间及住院时间较短，与改进前相比差异有统计学意义（P<0.05）。结论 新生儿肠道病毒感染以轻症为主，但重症感染病死率高；轻、重症患儿在实验室检查结果上存在一定差异。肠道病毒PCR、测序分型及抗生素管理改进措施对合理诊治有帮助。

Objective To analyze the clinical features of neonatal enterovirus infection and to explore the effect of antibiotic management improvement on reducing the use of antibiotics in children with enterovirus infection. Methods A retrospective analysis was performed on the clinical data of neonates diagnosed with enterovirus infection who were admitted to the Neonatal Department between January 2019 and December 2023. The subjects were categorized into a general infection group and a severe infection group based on the presence or absence of organ failure, and comparative analyses of clinical characteristics between the two groups were conducted. Results A total of 153 neonates with enterovirus infection were included in the study, with the peak incidence occurring from May to July. There were 94 boys and 59 girls. The gestational age was 39.3 (38.1-40.3) weeks, and the birth weight was 3200.0 (2950.0-3450.0) g. There were 35 early neonates, and the age of onset was 15.0 (8.0-23.0) days. Among all the patients, 146 had the initial symptoms of fever, 152 had fever during the course of the disease, and the course of fever was 1.8 (1.5-2.4) days. The median white blood cell count at admission was 5.0 (3.5-7.2)×10⁹/L and the median C-reactive protein level was 2.4 (0.5-7.3) mg/L. The median procalcitonin level was 0.2 (0.1-0.3) ng/mL. All 146 patients in the general infection group were discharged after improvement. Among the 7 patients with severe infection, 4 were complicated with hemorrhagic hepatitis syndrome and 2 died; 3 patients were complicated with myocarditis and 2 died. Compared with the general infection group, the infants in the severe infection group had a lower gestational age, a higher proportion of poor appetite and poor reaction during the course of the disease, lower hemoglobin and platelet counts, higher levels of lactic acid, aspartate aminotransferase, alanine aminotransferase, creatine kinase, and creatine kinase MB isoenzyme, with statistically significant differences (P<0.05). A total of 9 serotypes were detected in PCR positive samples of enterovirus, among which Coxsackie virus B3, Echovirus 12 and Echovirus 30 were the most common, accounting for 62.7%. After the implementation of antibiotic management quality improvement, the utilization rate of antibiotics was lower in neonates with enterovirus infection, and the duration of antibiotic use and hospital stay were shorter, and the differences were statistically significant (P<0.05). Conclusions The neonatal enterovirus infection is mainly mild, but the mortality of severe infection is high. There are some differences in the laboratory results between mild and severe patients. Enterovirus PCR, sequencing typing and antibiotic management improvement measures are helpful for reasonable diagnosis and treatment.