Delayed Acyclovir in Neonates With Herpes Ups Mortality

With overall in-hospital mortality rate of 7.3 percent for neonates with herpes simplex infection

WEDNESDAY, Nov. 30 (HealthDay News) -- Delayed initiation of acyclovir therapy in neonates with herpes simplex virus (HSV) infection is associated with in-hospital mortality, according to a study published online Nov. 28 in Pediatrics.

Samir S. Shah, M.D., M.S.C.E., from the Children's Hospital of Philadelphia, and colleagues assessed the correlation between delayed acyclovir therapy and mortality among 1,086 neonates (age ≤28 days; median age, 10 days) with HSV infection. Data were collected from 41 tertiary care children's hospitals between January 2003 and December 2009. Early acyclovir therapy was initiated within one day after hospital admission, and delayed therapy was initiated after one day and at/or before seven days after hospital admission. Propensity scores for each neonate's likelihood of receiving delayed acyclovir treatment were used to control for differences in illness severity between the groups.

The investigators found that 24.1 percent of the neonates received delayed acyclovir administration, and in 86.2 percent of these cases, acyclovir was administered on the second or third day of hospitalization. The overall mortality rate was 7.3 percent, with 9.5 and 6.6 percent of deaths occurring among those who received delayed and early acyclovir treatment, respectively. The odds of death in multivariate analyses were significantly greater with delayed versus early acyclovir therapy (adjusted odds ratio, 2.63).

"Delayed initiation of acyclovir therapy was associated with in-hospital death among neonates with HSV infection. Our data support the use of empiric acyclovir therapy for neonates undergoing testing for HSV infection," the authors write.

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