Andrea T Cruz1, Stephen B Freedman2, Dina M Kulik3, Pamela J Okada4, Alesia H Fleming5, Rakesh D Mistry6, Joanna E Thomson7, David Schnadower8, Joseph L Arms9, Prashant Mahajan10, Aris C Garro11, Christopher M Pruitt12, Fran Balamuth13, Neil G Uspal14, Paul L Aronson15, Todd W Lyons16, Amy D Thompson17, Sarah J Curtis18, Paul T Ishimine19, Suzanne M Schmidt20, Stuart A Bradin21, Kendra L Grether-Jones22, Aaron S Miller23, Jeffrey Louie24, Samir S Shah7, Lise E Nigrovic16. 1. Department of Pediatrics, Baylor College of Medicine, Houston, Texas; acruz@bcm.edu. 2. Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. 4. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas. 5. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. 6. Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. 7. Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 8. Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri. 9. Department of Pediatrics, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota. 10. Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan. 11. Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island. 12. Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 13. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 14. Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington. 15. Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut. 16. Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts. 17. Departments of Pediatrics and Emergency Medicine, Alfred I. DuPont Hospital for Children, Wilmington, Delaware. 18. Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. 19. Department of Emergency Medicine, University of California San Diego School of Medicine, San Diego, California. 20. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 21. Department of Pediatrics, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan. 22. Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California. 23. Department of Pediatrics, Saint Louis University School of Medicine, St Louis, Missouri; and. 24. Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.
Abstract
BACKGROUND: Although neonatal herpes simplex virus (HSV) is a potentially devastating infection requiring prompt evaluation and treatment, large-scale assessments of the frequency in potentially infected infants have not been performed. METHODS: We performed a retrospective cross-sectional study of infants ≤60 days old who had cerebrospinal fluid culture testing performed in 1 of 23 participating North American emergency departments. HSV infection was defined by a positive HSV polymerase chain reaction or viral culture. The primary outcome was the proportion of encounters in which HSV infection was identified. Secondary outcomes included frequency of central nervous system (CNS) and disseminated HSV, and HSV testing and treatment patterns. RESULTS: Of 26 533 eligible encounters, 112 infants had HSV identified (0.42%, 95% confidence interval [CI]: 0.35%-0.51%). Of these, 90 (80.4%) occurred in weeks 1 to 4, 10 (8.9%) in weeks 5 to 6, and 12 (10.7%) in weeks 7 to 9. The median age of HSV-infected infants was 14 days (interquartile range: 9-24 days). HSV infection was more common in 0 to 28-day-old infants compared with 29- to 60-day-old infants (odds ratio 3.9; 95% CI: 2.4-6.2). Sixty-eight (0.26%, 95% CI: 0.21%-0.33%) had CNS or disseminated HSV. The proportion of infants tested for HSV (35%; range 14%-72%) and to whom acyclovir was administered (23%; range 4%-53%) varied widely across sites. CONCLUSIONS: An HSV infection was uncommon in young infants evaluated for CNS infection, particularly in the second month of life. Evidence-based approaches to the evaluation for HSV in young infants are needed.
BACKGROUND: Although neonatal herpes simplex virus (HSV) is a potentially devastating infection requiring prompt evaluation and treatment, large-scale assessments of the frequency in potentially infected infants have not been performed. METHODS: We performed a retrospective cross-sectional study of infants ≤60 days old who had cerebrospinal fluid culture testing performed in 1 of 23 participating North American emergency departments. HSV infection was defined by a positive HSV polymerase chain reaction or viral culture. The primary outcome was the proportion of encounters in which HSV infection was identified. Secondary outcomes included frequency of central nervous system (CNS) and disseminated HSV, and HSV testing and treatment patterns. RESULTS: Of 26 533 eligible encounters, 112 infants had HSV identified (0.42%, 95% confidence interval [CI]: 0.35%-0.51%). Of these, 90 (80.4%) occurred in weeks 1 to 4, 10 (8.9%) in weeks 5 to 6, and 12 (10.7%) in weeks 7 to 9. The median age of HSV-infectedinfants was 14 days (interquartile range: 9-24 days). HSV infection was more common in 0 to 28-day-old infants compared with 29- to 60-day-old infants (odds ratio 3.9; 95% CI: 2.4-6.2). Sixty-eight (0.26%, 95% CI: 0.21%-0.33%) had CNS or disseminated HSV. The proportion of infants tested for HSV (35%; range 14%-72%) and to whom acyclovir was administered (23%; range 4%-53%) varied widely across sites. CONCLUSIONS: An HSV infection was uncommon in young infants evaluated for CNS infection, particularly in the second month of life. Evidence-based approaches to the evaluation for HSV in young infants are needed.
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