TY - JOUR
T1 - Herpes simplex virus infection among neonates suspected of invasive bacterial infection
T2 - a population-based cohort study
AU - Dungu, Kia Hee Schultz
AU - Lund, Stine
AU - Malchau Carlsen, Emma Louise
AU - Hartling, Ulla Birgitte
AU - Matthesen, Astrid Thaarup
AU - Franck, Kristina Træholt
AU - Thomsen, Marianne Kragh
AU - Justesen, Ulrik Stenz
AU - Nielsen, Hans Linde
AU - Nielsen, Alex Christian Yde
AU - Henriksen, Tine Brink
AU - Nygaard, Ulrikka
N1 - © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/5/24
Y1 - 2023/5/24
N2 - OBJECTIVE: To estimate the incidence of neonatal herpes simplex virus (HSV) infection and the number of neonates with suspected invasive bacterial infection (IBI) needed to treat (NNT) with acyclovir to ensure prompt treatment of invasive HSV infections.DESIGN: A nationwide population-based cohort study.SETTING: All neonatal and paediatric emergency departments in Denmark from 1 January 2010 to 31 December 2019.PATIENTS: Neonates aged 0-28 days with HSV infection.MAIN OUTCOME MEASURES: The main outcome measures were incidence and NNT. The NNT was calculated based on neonates with invasive HSV infection whose onset symptoms resembled IBI and the estimated number of Danish neonates who received antibiotics for suspected IBI.RESULTS: Fifty-four neonates with HSV infection were identified, that is, an incidence of 9 per 100 000 live births. Twenty presented with symptoms resembling IBI, all within the first 14 days of life. Of 18 (78%) neonates, 14 had elevated C reactive protein, 14 of 19 (74%) had elevated alanine aminotransferase and 11 of 17 (65%) had thrombocytopaenia. The estimated NNTs with empiric acyclovir at postnatal ages 0-3, 4-7 and 8-14 days were 1139 (95% CI 523 to 3103), 168 (95% CI 101 to 726) and 117 (95% CI 48 to 198), respectively.CONCLUSIONS: The incidence of neonatal HSV infection was higher than in previous decades; however, the estimated NNT with empiric acyclovir was high. Therefore, we propose not to treat all neonates suspected of IBI with empiric acyclovir, as current European guidelines suggest. However, HSV should be considered in neonates with signs of infection, especially after the third postnatal day and in neonates with high alanine aminotransferases and thrombocytopaenia.
AB - OBJECTIVE: To estimate the incidence of neonatal herpes simplex virus (HSV) infection and the number of neonates with suspected invasive bacterial infection (IBI) needed to treat (NNT) with acyclovir to ensure prompt treatment of invasive HSV infections.DESIGN: A nationwide population-based cohort study.SETTING: All neonatal and paediatric emergency departments in Denmark from 1 January 2010 to 31 December 2019.PATIENTS: Neonates aged 0-28 days with HSV infection.MAIN OUTCOME MEASURES: The main outcome measures were incidence and NNT. The NNT was calculated based on neonates with invasive HSV infection whose onset symptoms resembled IBI and the estimated number of Danish neonates who received antibiotics for suspected IBI.RESULTS: Fifty-four neonates with HSV infection were identified, that is, an incidence of 9 per 100 000 live births. Twenty presented with symptoms resembling IBI, all within the first 14 days of life. Of 18 (78%) neonates, 14 had elevated C reactive protein, 14 of 19 (74%) had elevated alanine aminotransferase and 11 of 17 (65%) had thrombocytopaenia. The estimated NNTs with empiric acyclovir at postnatal ages 0-3, 4-7 and 8-14 days were 1139 (95% CI 523 to 3103), 168 (95% CI 101 to 726) and 117 (95% CI 48 to 198), respectively.CONCLUSIONS: The incidence of neonatal HSV infection was higher than in previous decades; however, the estimated NNT with empiric acyclovir was high. Therefore, we propose not to treat all neonates suspected of IBI with empiric acyclovir, as current European guidelines suggest. However, HSV should be considered in neonates with signs of infection, especially after the third postnatal day and in neonates with high alanine aminotransferases and thrombocytopaenia.
KW - Acyclovir/therapeutic use
KW - Antiviral Agents/therapeutic use
KW - Child
KW - Cohort Studies
KW - Female
KW - Herpes Simplex/diagnosis
KW - Humans
KW - Infant, Newborn
KW - Pregnancy
KW - Pregnancy Complications, Infectious/epidemiology
KW - Thrombocytopenia/epidemiology
KW - infectious disease medicine
KW - neonatology
KW - sepsis
UR - http://www.scopus.com/inward/record.url?scp=85164400145&partnerID=8YFLogxK
U2 - 10.1136/archdischild-2023-325583
DO - 10.1136/archdischild-2023-325583
M3 - Journal article
C2 - 37225392
SN - 1359-2998
VL - 108
SP - 655
EP - 660
JO - Archives of Disease in Childhood. Fetal and Neonatal Edition
JF - Archives of Disease in Childhood. Fetal and Neonatal Edition
IS - 6
M1 - archdischild-2023-325583
ER -