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Empiric acyclovir for neonatal herpes simplex virus infection.

Christina Vanderpluym¹, Gerda Tawfik, Marilou Hervas-Malo

¹Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians

|October 14, 2011

Summary

Empiric acyclovir (ACV) is frequently used for suspected neonatal herpes simplex virus (NHSV) infection due to diagnostic challenges. While ACV appears safe and effective for NHSV, investigations are often incomplete.

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Published on: July 24, 2016

Area of Science:

Neonatal infectious diseases
Pediatric neurology
Pharmacology

Background:

Neonatal herpes simplex virus (NHSV) infection diagnosis is challenging, leading to increased empiric acyclovir (ACV) use.
Early diagnosis and treatment are crucial for improving outcomes in neonates with suspected HSV.

Purpose of the Study:

To review the utilization of ACV in neonatal populations.
To optimize the future management strategies for NHSV infections.

Main Methods:

Retrospective chart review of infants treated with intravenous ACV up to 43 days of life.
Data collected from January 2001 to February 2007 across five hospitals in Edmonton and Calgary.
Analysis of indications for ACV, diagnostic investigations performed, and adverse events.

Main Results:

ACV was initiated for 118 infants, predominantly for possible (N=115) versus proven (N=3) HSV infection.
Common indications included seizures (34%), hemodynamic instability (29%), and skin lesions (24%).
Diagnostic workup was often incomplete, with 4% having no specimens submitted for HSV detection; ACV-related nephrotoxicity was rare (3% in unproven cases).

Conclusions:

Clinicians consider NHSV in neonates with seizures, instability, or skin lesions but may need to increase suspicion for earlier treatment.
Diagnostic investigations for NHSV are frequently incomplete.
Empiric ACV for suspected NHSV appears to have a favorable safety profile with uncommon adverse events.