Neonates (children less than one month of age) have immature immune systems and are at higher risk for serious complications of bacterial and viral infections, including enteroviral (EV) diseases. Based on the high morbidity and mortality in this age group, the current standard of care for a febrile neonate dictates an evaluation to rule out and empirically treat serious bacterial infections pending culture results. More difficult is the evaluation of a neonate who presents with mild and nonspecific symptoms that are consistent with upper respiratory or viral processes. Infants with EV infections, vary in symptoms from self-limited disease to generalized multi-system organ failure, sepsis and death. Much of the care of the neonate with suspected or confirmed EV disease is supportive including treatment of the complications of EV disease. Because of the variation in presentation as well as the difficulty in management of these patients, controversy exists concerning the diagnosis of EV disease. The objective of this study is to determine physician awareness of EV infections in neonates and their testing practices. Conclusions Enterovirus And The Neonate: What We Know And What We Do. Karen N Goodman MD and Audrey Paul MDPhD Mount Sinai Medical Center, New York, New York Department of Emergency Medicine - Division of Pediatric Emergency Medicine Bibliography. 1.Caviness AC, Demmler GJ, Almendarez Y, Selwyn BJ. The prevalence of neonatal herpes simplex virus infection compared with serious bacterial illness in hospitalized neonates. J Pediatr. 2008;153: Baraff LJ, Bass JW, Fleisher GR, et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. agency for health care policy and research. Ann Emerg Med. 1993;22: Garra G, Cunningham SJ, Crain EF. Reappraisal of criteria used to predict serious bacterial illness in febrile infants less than 8 weeks of age. Acad Emerg Med. 2005;12: Byington CL, Enriquez FR, Hoff C, et al. Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections. Pediatrics. 2004;113: Abzug MJ. Presentation, diagnosis, and management of enterovirus infections in neonates. Paediatr Drugs. 2004;6: Dagan R. Nonpolio enteroviruses and the febrile young infant: Epidemiologic, clinical and diagnostic aspects. Pediatr Infect Dis J. 1996;15:67-71 Emergency medicine practitioners are not fully aware of some of the severe manifestations of EV disease. While severe manifestations of EV may be uncommon, they can be serious and life-threatening. Education and increasing awareness are important in order to make practitioners aware of these dangerous manifestations. This knowledge will help physicians in their disposition and discharge planning by giving parents concerning signs and symptoms to look for in their baby. While most practitioners meet the standard of care for the workup of a febrile neonate, only a small percentage of practitioners are testing for EV infections. Many do not test for EV because it will not affect their management of the patient. Future clinical trials addressing management of severe EV infections would have an impact on testing practices. Introduction Results Materials and methods A prospective blinded study using a standardized survey was administered through an online survey tool. Surveys were distributed in June 2009 through September Two listservs were used to enroll participants in the study: members of the New York Pediatric Emergency Medicine Society and the subscribers to EM Practice. All statistical analysis was performed using SPSS. Cross- tabulations were performed on particular questions. Descriptive statistics were used and chi-square analysis was done to determine significance of the results. Results Figure 1 illustrates the demographics of the 274 respondents to the survey. 97% of the respondents are involved in evaluating the neonate less than 28 days old. Figure 3 demonstrates practitioners most commonly reported that they do not send CSF EV PCR because it will not affect their management(48%) and because of lack of awareness.(40%). The ability to get rapid results affected the decision to send CSF EV PCR in only 24% of respondents with 59% reporting that they had never thought about it. There was a significant correlation between respondents saying they sent CSF EV PCR and their perceived knowledge score (p < 0.01, r = 0.245) Figure 2: CSF EV PCR is reported to be sent by 14.3% of the neonates evaluated for fever. Of those who send CSF EV PCR, there is no significant difference between physicians working in a PED or general ED (X2 0.14, P=0.43). Figure 2: Workup Figure 4: If treatment became available most respondents would consider testing for EV never definitely maybe probably Figure 4: Treatment effect on workup Figure 3: Awareness of EV manifestations