Clinical and Laboratory ObservationsThe Mortality of Neonatal Herpes Simplex Virus Infection
Section snippets
Methods
This is a retrospective case series of all infants who were admitted to Children's Medical Center (CMC) or Parkland Memorial Hospital (PMH), Dallas, Texas, from January 1, 2001, to December 31, 2011 at ≤42 days of age and died during acute HSV infection. Age ≤42 days was selected for screening to capture all infected infants who may have presented for medical care beyond the neonatal period despite onset of symptoms occurring in the first 28 days of age. All infants with HSV infection, not just
Results
During the 11-year study period, 13 (26%) of 50 infants diagnosed with HSV infection died and they comprise the study population. Overall, 7 (27%) of 26 infants with HSV-2 infection and 3 (14%) of 21 infants with HSV-1 infection died, as did the one infant coinfected with HSV-1 and HSV-2 and the 2 infants in whom the HSV type was not known. Most infants who died were male, black, and born vaginally; 6 (46%) were preterm (Table I). Eight had an identifiable maternal risk factor that may have
Discussion
The mortality of neonatal HSV infection remains high even in the acyclovir era. The 26% case-fatality rate in our cohort of neonates with HSV infection was greater than the 7% reported in a recent retrospective multicenter study4 or the 19% in a prospective active surveillance study of neonatal HSV disease in Australia.9 This difference likely is due to different case ascertainment methods as well as our review of all autopsies performed during the study period that identified three (23%)
References (21)
- et al.
Congenital herpes simplex type II infection
Am J Obstet Gynecol
(1985) Herpes simplex virus infections of the newborn
Semin Perinatol
(2007)- et al.
Herpes simplex virus hepatitis in infants: clinical outcomes and correlates of disease severity
J Pediatr
(2011) - et al.
Clinical and laboratory features of neonatal herpes simplex virus infection: a case-control study
Pediatr Infect Dis J
(2008) - et al.
Herpes simplex virus infection in young infants during 2 decades of empiric acyclovir therapy
Pediatr Infect Dis J
(2011) - et al.
Case records of the Massachusetts General Hospital. Case 19-2012. A premature newborn boy with respiratory distress
N Engl J Med
(2012) - et al.
Delayed acyclovir therapy and death among neonates with herpes simplex virus infection
Pediatrics
(2011) - et al.
Intrauterine herpes simplex virus infection
Teratology
(1989) - et al.
Natural History of Neonatal Herpes Simplex Virus Infections in the Acyclovir Era
Pediatrics
(2001) - et al.
Population-based surveillance of neonatal HSV infection in Australia (1997-2011)
Clin Infect Dis
(2014)
Cited by (16)
A Proposed Framework for the Clinical Management of Neonatal “Culture-Negative” Sepsis
2022, Journal of PediatricsDuring the Emergency Department Evaluation of a Well-Appearing Neonate with Fever, Should Empiric Acyclovir Be Initiated?
2018, Journal of Emergency MedicineCitation Excerpt :Consideration of testing and treatment for possible herpes simplex virus (HSV) infection in this situation is a controversial topic lacking evidence from well-designed clinical research. HSV infection of the newborn is a rare disease in the United States, with an incidence of 9.6/100,000, but it is associated with significant morbidity and mortality (1–3). Historically, HSV has been described with three different clinical manifestations: 1) Skin, Eyes, and Mouth disease; 2) central nervous system (CNS) encephalitis; and 3) disseminated.
Viral, Protozoan, and Related Intracranial Infections
2018, Volpe's Neurology of the NewbornNeonatal herpes: Epidemiology, clinical manifestations and management. Guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF)
2017, Gynecologie Obstetrique Fertilite et SenologieHost Defense Mechanisms Against Viruses
2017, Fetal and Neonatal Physiology, 2-Volume SetSkin infections in pregnancy
2016, Clinics in Dermatology
The authors declare no conflicts of interest.