Delayed acyclovir therapy and death among neonates with herpes simplex virus infection
- PMID: 22123868
- PMCID: PMC3387895
- DOI: 10.1542/peds.2011-0177
Delayed acyclovir therapy and death among neonates with herpes simplex virus infection
Abstract
Objective: To determine the association of delayed acyclovir therapy with death among neonates with herpes simplex virus (HSV) infection.
Methods: A multicenter, retrospective, cohort study was conducted between January 1, 2003, and December 31, 2009, with 1086 neonates (age: ≤28 days) with HSV infection from 41 tertiary care children's hospitals. Early acyclovir therapy was defined as initiation of intravenous acyclovir treatment within 1 day after hospital admission, and delayed acyclovir therapy was defined as initiation of treatment >1 and ≤7 days after hospital admission. Multivariate logistic regression models determined the association between delayed acyclovir therapy and death, with the use of propensity scores for each neonate's likelihood of receiving delayed acyclovir treatment to control for differences in illness severity between groups.
Results: The median age was 10 days. Delayed acyclovir therapy was administered to 262 neonates (24.1%). In most cases (86.2%) of delayed receipt, acyclovir administration occurred on the second or third day of hospitalization. The overall mortality rate was 7.3% (95% confidence interval: 5.8%-9.0%); 9.5% of those who received delayed acyclovir treatment and 6.6% of those who received early acyclovir treatment died. In a multivariate analysis, delayed acyclovir therapy was associated with significantly greater odds of death (adjusted odds ratio: 2.63 [95% confidence interval: 1.36-5.08]) compared with early acyclovir therapy.
Conclusions: In this multicenter observational study of neonates with HSV infection, delayed initiation of acyclovir therapy was associated with in-hospital death. Our data support the use of empiric acyclovir therapy for neonates undergoing testing for HSV infection.
Figures

Comment in
-
Delayed acyclovir therapy in neonates with herpes simplex virus infection is associated with an increased odds of death compared with early therapy.Evid Based Med. 2013 Apr;18(2):e20. doi: 10.1136/eb-2012-100674. Epub 2012 Jul 18. Evid Based Med. 2013. PMID: 22809516 No abstract available.
References
-
- Cohen DM, Lorch SA, King RL, Hodinka RL, Cohn KA, Shah SS. Factors influencing the decision to test young infants for herpes simplex virus infection. Pediatr Infect Dis J. 2007;26(12):1156–1158 - PubMed
-
- Caviness AC, Demmler GJ, Almendarez Y, Selwyn BJ. The prevalence of neonatal herpes simplex virus infection compared with serious bacterial illness in hospitalized neonates. J Pediatr. 2008;153(2):164–169 - PubMed
-
- Whitley RJ, Nahmias AJ, Soong SJ, Galasso GG, Fleming CL, Alford CA. Vidarabine therapy of neonatal herpes simplex virus infection. Pediatrics. 1980;66(4):495–501 - PubMed
-
- Kimberlin DW, Lin CY, Jacobs RF, et al. Natural history of neonatal herpes simplex virus infections in the acyclovir era. Pediatrics. 2001;108(2):223–229 - PubMed
-
- Whitley RJ, Corey L, Arvin A, et al. Changing presentation of herpes simplex virus infection in neonates. J Infect Dis. 1988;158(1):109–116 - PubMed
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Medical