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Investigators from Seattle Children’s Hospital (SCH) and the University of Washington, both in Seattle, WA, conducted a study to describe disease presentation and classification, viral type, treatment, and outcomes in infants with neonatal herpes simplex virus (HSV) disease and evaluation changes in outcomes over the period 1980–2016. Study participants were infants admitted to SCH with confirmed neonatal HSV during the study period. The medical records of these patients were reviewed and data on demographics, maternal history, clinical characteristics, and outcomes abstracted. Infants were classified as having skin-eye-mouth (SEM), disseminated (DIS) or central nervous system (CNS) HSV disease using established criteria, and also were categorized by viral type (HSV-1 or HSV-2). High dose (HD) acyclovir treatment was defined as a dose of 60 mg/kg/day intravenously for ≥21 days for children with DIS or CNS disease or ≥14 days for those with SEM. The mortality rates of each type of disease were determined, and trends in mortality were assessed by decade. For children who survived, neurologic outcomes were collected at 24 months of age, if available. Multivariate logistic regression was used to assess the association of receipt of HD acyclovir and death in infants with DIS or CNS disease. Rates of skin lesions at presentation and of recurrence by viral type also were compared.
Data were analyzed on 130 infants with neonatal HSV, including 44 (33.9%) with CNS, 39 (30.0%) with DIS, and 47 (36.2%) with SEM disease; 9 patients with DIS disease also had CNS involvement. Identified viral type was HSV-1 in 41.5% of study infants and HSV-2 in 56.2%. Overall, HSV-related mortality was 16.2%, ranging from 0% in infants with SEM, to 4.5% in those with CNS and 48.7% in patients with DIS disease. The mortality rate decreased from 20.9% in the 1980s to 5.6% since 2010 (P = 0.11). A total of 69 (53%) infants received HD acyclovir. Among infants with DIS or CNS disease, there was no statistically significant association between receipt of HD acyclovir and death (odds ratio, 0.55; 95% CI, 0.15, 2.03), but the power of this analysis was limited by the small sample size. Skin lesions were present at diagnosis in 63.8% of patients, including 35.9% with DIS, 65.9% with CNS, and 85.1% of those with SEM disease; 81.5% of children with HSV-1 disease had skin lesions compared to 50.7% of those with HSV-2. Rates of recurrence of skin lesions were significantly higher in those with HSV-2 disease than in patients with HSV-1 (80% vs 54.2%; P = 0.02). For patients with 24-month follow-up, 100%, 42.3%, and 70% of those with SEM, CNS and DIS disease, respectively, were considered to be neurologically normal.
The authors conclude that, despite advances in diagnosis and treatment of neonatal HSV disease, rates...
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