Elsevier

The Journal of Pediatrics

Volume 166, Issue 6, June 2015, Pages 1529-1532.e1
The Journal of Pediatrics

Clinical and Laboratory Observations
The Mortality of Neonatal Herpes Simplex Virus Infection

Portions of the study were presented at the Pediatric Academic Societies' Meeting, April 28-May 1, 2012, Boston, MA.
https://doi.org/10.1016/j.jpeds.2015.03.004Get rights and content

This retrospective study characterized the clinical course of 13 neonates who died with herpes simplex virus infection from 2001 to 2011, representing a 26% case-fatality rate. Fatal disease developed at ≤48 hours of age in one-third of infants, was mostly disseminated disease, and occurred despite early administration of high-dose acyclovir therapy.

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%)

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The authors declare no conflicts of interest.

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