Acute Kidney Injury During Treatment with Intravenous Acyclovir for Suspected or Confirmed Neonatal Herpes Simplex Virus Infection

Downes, Kevin J.; Boge, Craig L K; Baro, Elande; Wharton, Gerold T.; Liston, Kellie; Haltzman, Brittany L.; Emerson, Hannah; Doe, Edwin; Fulchiero, Rosanna; Tran, Vân Nam; Yen, Lilly; Lieu, Phuong; Driest, Sara L. Van; Grisso, Alison G.; Aka, Ida; Hale, Jennifer; Gillon, Jessica; Pingel, Julie; Coffin, Susan; McMahon, Ann

doi:10.1016/j.jpeds.2019.12.056

Cited by 15 publications

(4 citation statements)

References 19 publications

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“…Most newborns exposed to HSV do not develop a disseminated infection, which calls into question the need for acyclovir treatment, given the association of this drug with neutropenia and nephrotoxicity in neonates [ 7 ]. However, the consequences of delaying treatment can be fatal in disseminated infections, and the risk-benefit ratio dictates that when there is a clinical suspicion of this form, we should start the infant on empirical treatment after taking several samples for microbiological analysis (including samples of the conjunctival, buccal, nasopharyngeal, and rectal surface; a swab or scrape from the cutaneous or mucosal lesions; and blood and CSF samples for HSV PCR).…”

Section: Discussionmentioning

confidence: 99%

“…Acyclovir is administered intravenously at a dose of 20 mg/kg (or a renal function-adjusted dose) every eight hours for 14 days in the case of skin/mucosal herpes, or 21 days for disseminated or CNS infection, followed by oral acyclovir at 300 mg/m 2 every eight hours for six months. The infant must be monitored for possible recurrence, sequelae, or drug-related adverse events [ 3 , 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Herpes Simplex Virus Infection in Neonates Born to Asymptomatic Mothers: A Case Series

Pujol¹,

Simon²,

Sanguino³

et al. 2022

Cureus

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Neonatal herpes is a rare condition and it is normally acquired through vertical transmission in the peripartum period. Delayed diagnosis and treatment of this condition are associated with high morbidity and mortality. We present five cases of neonatal herpes in infants born to asymptomatic mothers. Three of these infants were girls, three were born preterm, three were born after prolonged rupture of membranes, three had herpes simplex virus (HSV) type 2, and one had central nervous system (CNS) involvement. In all cases, the dermatologist played a key role in establishing an early diagnosis. Given the absence of a vaccine or a cost-effective method of screening for HSV infection in asymptomatic mothers, the current management strategies focus on the prevention of maternal infection and mother-to-child transmission, as well as early diagnosis and treatment of neonatal infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Herpes Simplex Virus Infection in Neonates Born to Asymptomatic Mothers: A Case Series

Pujol¹,

Simon²,

Sanguino³

et al. 2022

Cureus

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“…30 Aciclovir is usually divided as thrice-daily dosing for 14 days, or 21 days if disease is disseminated or with CNS involvement. Renal toxicity (5.6% (57/ 1017) in neonates in one retrospective US cohort study from 2011 to 2015 occurred more often in those with intensive care stay or mechanical ventilation 31 and neutropenia (21% of 29 neonates; all spontaneously resolved 30 ) but these significant side effects require careful monitoring.…”

Section: Current Treatmentsmentioning

confidence: 99%

Management of neonatal central nervous system viral infections: Knowledge gaps and research priorities

Abeywickrema

Kelly

Kadambari

2023

Reviews in Medical Virology

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Congenital CMV, enteroviruses, human parechovirus and herpes simplex virus are all common causes of severe central nervous system (CNS) infection in neonates.The introduction of screening (i.e. newborn hearing screening programme), integration of molecular syndromic testing (i.e. multiplex polymerase chain reaction assays) and increase in sexually transmitted infections (i.e. anogenital herpes) have contributed to increases in each of these infections over the last decade. However, therapeutic options are highly limited in part due to the lack of epidemiological data informing trials. This review will describe our current understanding of the clinical burden and epidemiology of these severe neonatal CNS infections, outline the novel antiviral and vaccines in the pipeline and suggest future research studies which could help develop new therapeutics.

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“…Moreover, the results from molecular analysis of CSF, including PCR for HSV, are currently quickly available, allowing the discontinuation of acyclovir after a few doses when not necessary and minimizing the impact of acyclovir use on the hospital length of stay and costs. Regarding the potential nephrotoxicity of acyclovir, recent studies reported that adverse effects can be common but are usually not severe, and the risk for acute kidney injury is increased in sicker patients who need intensive care, in patients with confirmed HSV infections, and in patients receiving concomitant nephrotoxic drugs, suggesting that most events may be related to the underlying clinical conditions [78][79][80][81]. To date, empiric acyclovir treatment in patients with suspected viral CNS infection remains recommended until HSV infection is excluded.…”

Section: Treatmentmentioning

confidence: 99%

Update on Viral Infections Involving the Central Nervous System in Pediatric Patients

et al. 2021

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Infections of the central nervous system (CNS) are mainly caused by viruses, and these infections can be life-threatening in pediatric patients. Although the prognosis of CNS infections is often favorable, mortality and long-term sequelae can occur. The aims of this narrative review were to describe the specific microbiological and clinical features of the most frequent pathogens and to provide an update on the diagnostic approaches and treatment strategies for viral CNS infections in children. A literature analysis showed that the most common pathogens worldwide are enteroviruses, arboviruses, parechoviruses, and herpesviruses, with variable prevalence rates in different countries. Lumbar puncture (LP) should be performed as soon as possible when CNS infection is suspected, and cerebrospinal fluid (CSF) samples should always be sent for polymerase chain reaction (PCR) analysis. Due to the lack of specific therapies, the management of viral CNS infections is mainly based on supportive care, and empiric treatment against herpes simplex virus (HSV) infection should be started as soon as possible. Some researchers have questioned the role of acyclovir as an empiric antiviral in older children due to the low incidence of HSV infection in this population and observed that HSV encephalitis may be clinically recognizable beyond neonatal age. However, the real benefit-risk ratio of selective approaches is unclear, and further studies are needed to define appropriate indications for empiric acyclovir. Research is needed to find specific therapies for emerging pathogens. Moreover, the appropriate timing of monitoring neurological development, performing neuroimaging evaluations and investigating the effectiveness of rehabilitation during follow-up should be evaluated with long-term studies.

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Acute Kidney Injury During Treatment with Intravenous Acyclovir for Suspected or Confirmed Neonatal Herpes Simplex Virus Infection

Cited by 15 publications

References 19 publications

Herpes Simplex Virus Infection in Neonates Born to Asymptomatic Mothers: A Case Series

Herpes Simplex Virus Infection in Neonates Born to Asymptomatic Mothers: A Case Series

Management of neonatal central nervous system viral infections: Knowledge gaps and research priorities

Update on Viral Infections Involving the Central Nervous System in Pediatric Patients

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