Neonatal herpes simplex virus infections. Presentation and management

Area of Science:

• Virology
• Neonatal Medicine
• Infectious Diseases

Background:

• Neonatal herpes simplex virus (HSV) infections pose significant risks for infant morbidity and mortality.
• Understanding the presentation, natural history, and outcomes of neonatal HSV is crucial for effective management.

Purpose of the Study:

• To evaluate the effectiveness of antiviral chemotherapy in treating neonatal HSV infections.
• To analyze outcomes based on disease classification: disseminated, central nervous system (CNS), or skin, eye, and mouth (SEM).

Main Methods:

• Analysis of ongoing studies by the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group.
• Classification of neonatal HSV infections into disseminated, localized CNS disease, or localized SEM disease.
• Comparison of vidarabine treatment outcomes against placebo in affected infants.

Main Results:

• Vidarabine administration (15 or 30 mg/kg/day) significantly decreased mortality in infants with disseminated and CNS disease compared to placebo.
• Approximately one-third of infants with disseminated or CNS disease experienced normal development post-treatment.
• Infants with localized SEM disease had no deaths and 88% normal development following treatment.

Conclusions:

• Antiviral therapy, including vidarabine, is effective in managing neonatal HSV infections, particularly reducing mortality in severe cases.
• Outcomes are strongly dependent on the classification and extent of the HSV infection.
• Further research, including studies on acyclovir, is needed to improve treatment outcomes for neonatal HSV.