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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...
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| Published in: | Pediatrics (Evanston) 2001-08, Vol.108 (2), p.223-229 |
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| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1542/peds.108.2.223 |
| format | article |
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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 the interval between onset of HSV symptoms and initiation of antiviral therapy. Additional strides in the improvement of disease outcome may occur only if the interval between onset of symptoms and initiation of therapy is shortened. The means by which this will be accomplished lie in increased consideration of neonatal HSV infections in acutely ill infants. Specific data and recommendations to facilitate this goal are contained within.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.108.2.223</identifier><identifier>PMID: 11483781</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Elk Grove Village, IL: Am Acad Pediatrics</publisher><subject>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</subject><ispartof>Pediatrics (Evanston), 2001-08, Vol.108 (2), p.223-229</ispartof><rights>2002 INIST-CNRS</rights><rights>COPYRIGHT 2001 American Academy of Pediatrics</rights><rights>COPYRIGHT 2001 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Aug 2001</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-f33cbb6c890dd3c26171d2c9ad5efe5f267ef7575e75c263dec112dc29c63f693</citedby><cites>FETCH-LOGICAL-c525t-f33cbb6c890dd3c26171d2c9ad5efe5f267ef7575e75c263dec112dc29c63f693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,783,787,27936,27937</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14072083$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11483781$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kimberlin, David W</creatorcontrib><creatorcontrib>Lin, Chin-Yu</creatorcontrib><creatorcontrib>Jacobs, Richard F</creatorcontrib><creatorcontrib>Powell, Dwight A</creatorcontrib><creatorcontrib>Frenkel, Lisa M</creatorcontrib><creatorcontrib>Gruber, William C</creatorcontrib><creatorcontrib>Rathore, Mobeen</creatorcontrib><creatorcontrib>Bradley, John S</creatorcontrib><creatorcontrib>Diaz, Pamela S</creatorcontrib><creatorcontrib>Kumar, Mary</creatorcontrib><creatorcontrib>Arvin, Ann M</creatorcontrib><creatorcontrib>Gutierrez, Kathleen</creatorcontrib><creatorcontrib>Shelton, Mark</creatorcontrib><creatorcontrib>Weiner, Leonard B</creatorcontrib><creatorcontrib>Sleasman, John W</creatorcontrib><creatorcontrib>de Sierra, Teresa Murguia</creatorcontrib><creatorcontrib>Soong, Seng-Jaw</creatorcontrib><creatorcontrib>Kiell, Jan</creatorcontrib><creatorcontrib>Lakeman, Fred D</creatorcontrib><creatorcontrib>Whitley, Richard J</creatorcontrib><creatorcontrib>National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group</creatorcontrib><creatorcontrib>the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Groupa</creatorcontrib><title>Natural History of Neonatal Herpes Simplex Virus Infections in the Acyclovir Era</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>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 the interval between onset of HSV symptoms and initiation of antiviral therapy. Additional strides in the improvement of disease outcome may occur only if the interval between onset of symptoms and initiation of therapy is shortened. The means by which this will be accomplished lie in increased consideration of neonatal HSV infections in acutely ill infants. Specific data and recommendations to facilitate this goal are contained within.</description><subject>Acyclovir</subject><subject>Acyclovir - administration & dosage</subject><subject>Acyclovir - therapeutic use</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiviral agents</subject><subject>Antiviral Agents - administration & dosage</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Aspartate Aminotransferases - blood</subject><subject>Biological and medical sciences</subject><subject>Diagnosis, Differential</subject><subject>Diagnostic Imaging</subject><subject>Diseases</subject><subject>Drug therapy</subject><subject>Electroencephalography - statistics & numerical data</subject><subject>Health aspects</subject><subject>Herpes simplex</subject><subject>Herpes Simplex - diagnosis</subject><subject>Herpes Simplex - drug therapy</subject><subject>Herpes Simplex - microbiology</subject><subject>Herpes viruses</subject><subject>Herpesvirus 1, Human - drug effects</subject><subject>Herpesvirus 1, Human - isolation & purification</subject><subject>Herpesvirus 2, Human - drug effects</subject><subject>Herpesvirus 2, Human - isolation & purification</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infant, Premature, Diseases - diagnosis</subject><subject>Infant, Premature, Diseases - drug therapy</subject><subject>Infants (Newborn)</subject><subject>Infusions, Parenteral</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Neonatal care</subject><subject>Neonatal diseases</subject><subject>Pediatrics</subject><subject>Pharmacology. Drug treatments</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Treatment Outcome</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><recordid>eNpt0c1v0zAUAHALgVg3uHJEERKIAwn-iGPnWFVjm1RtSHxcLdd5bj2lcWY7sP73c9VKBcTJXz-_9-yH0BuCK8Jr-nmELlYEy4pWlLJnaEZwK8uaCv4czTBmpKwx5mfoPMZ7jHHNBX2JzgipJROSzNDXW52moPvi2sXkw67wtrgFP-i034MwQiy-ue3Yw2Px04UpFjeDBZOcH2LhhiJtoJibnen9LxeKy6BfoRdW9xFeH8cL9OPL5ffFdbm8u7pZzJel4ZSn0jJmVqvGyBZ3HTO0IYJ01LS642CBW9oIsIILDoLnU9aBIYR2hramYbZp2QX6cIg7Bv8wQUxq66KBvtcD-CkqQXBTN6TJ8N0_8N5PYci1KUolk_kreEYfD2ite1BuMH5I8JjWeopRyaulmgtRSywIzfTT_6jxfQ9rUPmRi7u_eHXgJvgYA1g1BrfVYacIVvsWqn0L80Iqmgti-cLbY73TagvdiR97lsH7I9DR6N4GPRgXT67GgmLJTpk3br357QLsMzmdgjPxj-kp8xPN6LKv</recordid><startdate>20010801</startdate><enddate>20010801</enddate><creator>Kimberlin, David W</creator><creator>Lin, Chin-Yu</creator><creator>Jacobs, Richard F</creator><creator>Powell, Dwight A</creator><creator>Frenkel, Lisa M</creator><creator>Gruber, William C</creator><creator>Rathore, Mobeen</creator><creator>Bradley, John S</creator><creator>Diaz, Pamela S</creator><creator>Kumar, Mary</creator><creator>Arvin, Ann M</creator><creator>Gutierrez, Kathleen</creator><creator>Shelton, Mark</creator><creator>Weiner, Leonard B</creator><creator>Sleasman, John W</creator><creator>de Sierra, Teresa Murguia</creator><creator>Soong, Seng-Jaw</creator><creator>Kiell, Jan</creator><creator>Lakeman, Fred D</creator><creator>Whitley, Richard J</creator><general>Am Acad Pediatrics</general><general>American Academy of Pediatrics</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20010801</creationdate><title>Natural History of Neonatal Herpes Simplex Virus Infections in the Acyclovir Era</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-f33cbb6c890dd3c26171d2c9ad5efe5f267ef7575e75c263dec112dc29c63f693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Acyclovir</topic><topic>Acyclovir - administration & dosage</topic><topic>Acyclovir - therapeutic use</topic><topic>Antibiotics. 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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 the interval between onset of HSV symptoms and initiation of antiviral therapy. Additional strides in the improvement of disease outcome may occur only if the interval between onset of symptoms and initiation of therapy is shortened. The means by which this will be accomplished lie in increased consideration of neonatal HSV infections in acutely ill infants. Specific data and recommendations to facilitate this goal are contained within.</abstract><cop>Elk Grove Village, IL</cop><pub>Am Acad Pediatrics</pub><pmid>11483781</pmid><doi>10.1542/peds.108.2.223</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0031-4005 |
| ispartof | Pediatrics (Evanston), 2001-08, Vol.108 (2), p.223-229 |
| issn | 0031-4005 1098-4275 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_71064616 |
| source | EZB Electronic Journals Library |
| 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 |
| title | Natural History of Neonatal Herpes Simplex Virus Infections in the Acyclovir Era |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-11-13T07%3A39%3A02IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Natural%20History%20of%20Neonatal%20Herpes%20Simplex%20Virus%20Infections%20in%20the%20Acyclovir%20Era&rft.jtitle=Pediatrics%20(Evanston)&rft.au=Kimberlin,%20David%20W&rft.aucorp=National%20Institute%20of%20Allergy%20and%20Infectious%20Diseases%20Collaborative%20Antiviral%20Study%20Group&rft.date=2001-08-01&rft.volume=108&rft.issue=2&rft.spage=223&rft.epage=229&rft.pages=223-229&rft.issn=0031-4005&rft.eissn=1098-4275&rft.coden=PEDIAU&rft_id=info:doi/10.1542/peds.108.2.223&rft_dat=%3Cgale_proqu%3EA77480712%3C/gale_proqu%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c525t-f33cbb6c890dd3c26171d2c9ad5efe5f267ef7575e75c263dec112dc29c63f693%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=228381485&rft_id=info:pmid/11483781&rft_galeid=A77480712&rfr_iscdi=true |