Natural History of Neonatal Herpes Simplex Virus Infections in the Acyclovir Era

During the 2 decades in which effective antiviral therapies have been available for neonatal herpes simplex virus (HSV) disease, changes have been documented not only in the outcomes of infected infants, but also in the natural history of the disease itself. Numerous studies previously have reported...

Full description

Saved in:
Bibliographic Details
Published in:Pediatrics (Evanston) 2001-08, Vol.108 (2), p.223-229
Main Authors: Kimberlin, David W, Lin, Chin-Yu, Jacobs, Richard F, Powell, Dwight A, Frenkel, Lisa M, Gruber, William C, Rathore, Mobeen, Bradley, John S, Diaz, Pamela S, Kumar, Mary, Arvin, Ann M, Gutierrez, Kathleen, Shelton, Mark, Weiner, Leonard B, Sleasman, John W, de Sierra, Teresa Murguia, Soong, Seng-Jaw, Kiell, Jan, Lakeman, Fred D, Whitley, Richard J
Format: Article
Language:English
Subjects:
Acyclovir
Acyclovir - administration & dosage
Acyclovir - therapeutic use
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antiviral agents
Antiviral Agents - administration & dosage
Antiviral Agents - therapeutic use
Aspartate Aminotransferases - blood
Biological and medical sciences
Diagnosis, Differential
Diagnostic Imaging
Diseases
Drug therapy
Electroencephalography - statistics & numerical data
Health aspects
Herpes simplex
Herpes Simplex - diagnosis
Herpes Simplex - drug therapy
Herpes Simplex - microbiology
Herpes viruses
Herpesvirus 1, Human - drug effects
Herpesvirus 1, Human - isolation & purification
Herpesvirus 2, Human - drug effects
Herpesvirus 2, Human - isolation & purification
Humans
Infant
Infant, Newborn
Infant, Premature, Diseases - diagnosis
Infant, Premature, Diseases - drug therapy
Infants (Newborn)
Infusions, Parenteral
Medical research
Medical sciences
Neonatal care
Neonatal diseases
Pediatrics
Pharmacology. Drug treatments
Proportional Hazards Models
Prospective Studies
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:During the 2 decades in which effective antiviral therapies have been available for neonatal herpes simplex virus (HSV) disease, changes have been documented not only in the outcomes of infected infants, but also in the natural history of the disease itself. Numerous studies previously have reported that early institution of antiviral therapy is beneficial to the outcome of the disease. The objective of this study was to provide an update of neonatal HSV disease to identify means by which future improvements in the management of HSV-infected neonates can be made. Neonates enrolled in 2 studies of parenteral acyclovir for the treatment of neonatal HSV disease provided the data source. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group conducted the studies between 1981 and 1997. A total of 186 patients are summarized, all of whom were treated with acyclovir. Demographic and clinical characteristics of these patients are reported. Comparisons between patients treated in the periods between 1981-1988 and 1989-1997 according to extent of disease revealed that the mean time between the onset of disease symptoms and initiation of therapy has not changed significantly from the early 1980s to the late 1990s. Of all patients evaluated, 40% had fetal scalp monitors during the delivery process. A significant minority of patients did not have skin vesicles at the time of their presentation and did not develop them during the acute HSV disease (39% of patients with disseminated disease; 32% of patients with central nervous system [CNS] disease; and 17% of patients with skin, eye, and/or mouth disease). Among patients with CNS disease, mortality was associated with prematurity. Among patients with disseminated HSV disease treated with acyclovir at 30 mg/kg/d, mortality was associated with aspartate transaminase elevations of >/=10 times the upper limit of normal at the time of initiation of acyclovir therapy. Mortality was also associated with lethargy at initiation of antiviral therapy for patients with disseminated disease. Patients' morbidity status was associated with the extent of disease (skin, eye, and/or mouth disease vs CNS vs disseminated). For those patients with CNS disease, morbidity was also associated with seizures at initiation of antiviral therapy. Data presented in the current comparison of neonatal HSV disease over the 2 periods (1981-1988 vs 1989-1997) demonstrate that no progress has been made in decreasing
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.108.2.223