RFID MIDDLEWARE

continued vigilance for cardiac symptoms in patients with sepsis-like presentation remains important, but our findings do not support cardiac screening in all infants with EV or HPeV sepsis-like illness.

Acknowledgements

We kindly thank Annelies van der Hulst (AH) and Liselotte Klitsie (LK) for their assistance with the echocardiographic images measurements. This study received financial support from the ‘HAGA hospital Scientific Fund’ and a grant from the Foundation ‘Friends of Juliana Children’s hospital’.

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‘Viral infections in young infants’ is an immense topic that could (and should) never be completely discussed in one thesis. Therefore, choices to limit to the scope of this thesis were made and we decided to discuss two different groups of paediatric viral infections; first ‘ToRCH’ infections (part A) and secondly Enterovirus (EV) and Human Parechovirus infections (HPeV) (part B).

Congenital (ToRCH) infections have a relatively low incidence in The Netherlands but are frequently tested for a variety of different indications. Two frequent indications for ‘ToRCH testing’, lenticulostriate vasculopathy (LSV) and small for gestational age (SGA), were evaluated in chapter 2 and 3, respectively. General diagnostic considerations on ToRCH- testing from a pathophysiology and laboratory perspective were reviewed in chapter 4. ToRCH-testing is requested relatively often in daily clinical practice, but EV- and HPeV testing is not always integrated in standard of care, even though they occur frequently in young infants with sepsis-like illness. Therefore, this diagnosis can be easily missed. The added knowledge from our large epidemiology study (chapter 5) and smaller follow-up studies from a non-intensive care point of view (chapters 6 and 7) will improve the general paediatrician’s capability to provide adequate follow-up after EV or HPeV infection and better inform parents about what to expect after hospital release.

In this general discussion, the main findings and the methodological challenges of the studies in this thesis are mentioned and put in a broader scientific perspective. This is followed by a review of the clinical consequences of the conclusions of this thesis. Finally, suggestions for further research are provided.