You are here

Article Text

Article menu
Download PDFPDF
Original research
Herpes simplex virus infection among neonates suspected of invasive bacterial infection: a population-based cohort study
  1. Kia Hee Schultz Dungu1,
  2. Stine Lund2,
  3. Emma Louise Malchau Carlsen2,
  4. Ulla Birgitte Hartling3,
  5. Astrid Thaarup Matthesen4,
  6. Kristina Træholt Franck5,
  7. Marianne Kragh Thomsen6,
  8. Ulrik Stenz Justesen7,
  9. Hans Linde Nielsen8,
  10. Alex Christian Yde Nielsen9,
  11. Tine Brink Henriksen10,11,
  12. Ulrikka Nygaard1
  1. 1 Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
  2. 2 Department of Neonatology, Copenhagen University Hospital, Copenhagen, Denmark
  3. 3 Department of Paediatrics and Adolescent Medicine, Odense University Hospital, Odense, Denmark
  4. 4 Department of Paediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
  5. 5 Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
  6. 6 Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
  7. 7 Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
  8. 8 Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
  9. 9 Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
  10. 10 Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
  11. 11 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Kia Hee Schultz Dungu, Department of Paediatrics & Adolescent Medicine, Copenhagen University Hospital, Copenhagen DK-2100, Denmark; kia.hee.schultz.dungu{at}regionh.dk

Abstract

Objective To estimate the incidence of neonatal herpes simplex virus (HSV) infection and the number of neonates with suspected invasive bacterial infection (IBI) needed to treat (NNT) with acyclovir to ensure prompt treatment of invasive HSV infections.

Design A nationwide population-based cohort study.

Setting All neonatal and paediatric emergency departments in Denmark from 1 January 2010 to 31 December 2019.

Patients Neonates aged 0–28 days with HSV infection.

Main outcome measures The main outcome measures were incidence and NNT. The NNT was calculated based on neonates with invasive HSV infection whose onset symptoms resembled IBI and the estimated number of Danish neonates who received antibiotics for suspected IBI.

Results Fifty-four neonates with HSV infection were identified, that is, an incidence of 9 per 100 000 live births. Twenty presented with symptoms resembling IBI, all within the first 14 days of life. Of 18 (78%) neonates, 14 had elevated C reactive protein, 14 of 19 (74%) had elevated alanine aminotransferase and 11 of 17 (65%) had thrombocytopaenia. The estimated NNTs with empiric acyclovir at postnatal ages 0–3, 4–7 and 8–14 days were 1139 (95% CI 523 to 3103), 168 (95% CI 101 to 726) and 117 (95% CI 48 to 198), respectively.

Conclusions The incidence of neonatal HSV infection was higher than in previous decades; however, the estimated NNT with empiric acyclovir was high. Therefore, we propose not to treat all neonates suspected of IBI with empiric acyclovir, as current European guidelines suggest. However, HSV should be considered in neonates with signs of infection, especially after the third postnatal day and in neonates with high alanine aminotransferases and thrombocytopaenia.

  • neonatology
  • infectious disease medicine
  • sepsis

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/archdischild-2023-325583

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request.

    View Full Text

    Footnotes

    • Contributors KHSD, UN and TBH conceptualised and designed the study, collected the data, performed data analyses and interpretation, drafted the initial manuscript, and critically reviewed and revised the manuscript. SL, ELMC, UBH and ATM helped conceptualise the study, interpreted the data, and critically reviewed and revised the manuscript. KTF, MKT, HLN, ACYN and USJ helped collect data, conceptualised the study, interpreted the data, and critically reviewed and revised the manuscript. All authors approved the final manuscript and agree to be accountable for all aspects of the work. Guarantor is KHSD.

    • Funding This work was supported by the Innovation Fund Denmark (grant number 0176–00020B).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

    Linked Articles

    • Highlights from this issue
      Fantoms
      Ben J Stenson
      Archives of Disease in Childhood - Fetal and Neonatal Edition 2023; 108 551-551 Published Online First: 19 Oct 2023. doi: 10.1136/archdischild-2023-326446