some neonates have been reported to have a very low glucose level Enteroviral PCR sent from CSF samples is diagnostic PCR can also be sent from serum, urine, nasopharyngeal, and stool samples Blood cultures are negative, differentiating enteroviral from bacterial sepsis It should be noted that 3% of neonates evaluated for suspected bacterial sepsis will have an enteroviral infection Although viral cultures are the traditional methods of diagnosis, it may take longer to obtain results PCR is sensitive and is a faster test Liver function tests may reveal an acute elevation of transaminases and there may be coagulopathy CXR may reveal infiltrates or cardiomegaly with pulmonary edema Echocardiography is needed for cases with arrhythmia or signs of low cardiac output Enteroviral disease should be differentiated from other causes of neonatal sepsis, acute fulminant hepatitis, and myocarditis In mild cases, spontaneous recovery is the rule In severe cases, mortality rate can reach 50% for those with myocarditis and 31% for those with fulminant hepatic failure and coagulopathy Sudden infant death syndrome has also been reported with enteroviral infections Management of the newborn is directed toward fluid resuscitation, maintaining adequate blood pressure with pressors if needed, and supportive care Neonates should be admitted to an intensive care unit and contact precautions instituted High-dose intravenous immunoglobulin may be administered once diagnosis has been determined Special Considerations Delivery in the ED Pediatric emergency physicians may find themselves in a position where they must attend a precipitous delivery of a newborn The following section reviews the key points of delivering a fetus in a cephalic position KEY POINTS