Ann J Melvin1, Kathleen M Mohan1, Surabhi B Vora1, Stacy Selke2, Erin Sullivan3, Anna Wald2,4,5,6. 1. Department of Pediatrics, Division of Pediatric Infectious Disease, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA. 2. Department of Laboratory Medicine & Pathology, University of Washington, Seattle, Washington, USA. 3. Biostatistics Epidemiology and Analytics for Research Core, Seattle Children's Research Institute, Seattle, Washington, USA. 4. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. 5. Department of Medicine, University of Washington, Seattle, Washington, USA. 6. Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Abstract
BACKGROUND: Over the past several decades, there have been advances in diagnosis and treatment of neonatal herpes simplex virus (HSV) disease. There has been no recent comprehensive evaluation of the impact of these advances on the management and outcomes for neonates with HSV. METHODS: Clinical data for initial presentation, treatment, and outcomes were abstracted from medical records of neonates with HSV treated at Seattle Children's Hospital between 1980 and 2016. RESULTS: One hundred thirty infants with a diagnosis of neonatal HSV were identified. Between 1980 and 2016, high-dose acyclovir treatment for neonatal HSV infection increased from 0% to close to 95%, with subsequent decrease in overall HSV-related mortality from 20.9% to 5.6%. However, even among infants treated with high-dose acyclovir, mortality was 40.9% for infants with disseminated (DIS) disease, and only 55% of infants with central nervous system (CNS) disease were without obvious neurologic abnormalities at 24 months. Over the study period, the time between initial symptoms and diagnosis decreased. Skin recurrences were more common with HSV-2 than HSV-1 (80% vs 55%; P = .02) and in infants with lesions at initial diagnosis (76% vs 47%; P = .02). CONCLUSION: Changes in the standard of care for management of neonatal HSV disease have led to improvements in timeliness of diagnosis and outcome but mortality in infants with DIS disease and neurologic morbidity in infants with CNS disease remain high. Future research should focus on prevention of perinatal infection and subsequent recurrences.
BACKGROUND: Over the past several decades, there have been advances in diagnosis and treatment of neonatal herpes simplex virus (HSV) disease. There has been no recent comprehensive evaluation of the impact of these advances on the management and outcomes for neonates with HSV. METHODS: Clinical data for initial presentation, treatment, and outcomes were abstracted from medical records of neonates with HSV treated at Seattle Children's Hospital between 1980 and 2016. RESULTS: One hundred thirty infants with a diagnosis of neonatal HSV were identified. Between 1980 and 2016, high-dose acyclovir treatment for neonatal HSV infection increased from 0% to close to 95%, with subsequent decrease in overall HSV-related mortality from 20.9% to 5.6%. However, even among infants treated with high-dose acyclovir, mortality was 40.9% for infants with disseminated (DIS) disease, and only 55% of infants with central nervous system (CNS) disease were without obvious neurologic abnormalities at 24 months. Over the study period, the time between initial symptoms and diagnosis decreased. Skin recurrences were more common with HSV-2 than HSV-1 (80% vs 55%; P = .02) and in infants with lesions at initial diagnosis (76% vs 47%; P = .02). CONCLUSION: Changes in the standard of care for management of neonatal HSV disease have led to improvements in timeliness of diagnosis and outcome but mortality in infants with DIS disease and neurologic morbidity in infants with CNS disease remain high. Future research should focus on prevention of perinatal infection and subsequent recurrences.
Authors: Joseph B Cantey; Asuncion Mejías; Rebecca Wallihan; Christopher Doern; Evangeline Brock; Douglas Salamon; Mario Marcon; Pablo J Sánchez Journal: J Pediatr Date: 2012-05-19 Impact factor: 4.406
Authors: D W Kimberlin; C Y Lin; R F Jacobs; D A Powell; L Corey; W C Gruber; M Rathore; J S Bradley; P S Diaz; M Kumar; A M Arvin; K Gutierrez; M Shelton; L B Weiner; J W Sleasman; T M de Sierra; S Weller; S J Soong; J Kiell; F D Lakeman; R J Whitley Journal: Pediatrics Date: 2001-08 Impact factor: 7.124
Authors: Ann J Melvin; Kathleen M Mohan; Joshua T Schiffer; Linda M Drolette; Amalia Magaret; Lawrence Corey; Anna Wald Journal: J Pediatr Date: 2014-12-06 Impact factor: 4.406