Vanderpluym Christina, Tawfik Gerda, Hervas-Malo Marilou, Lacaze-Masmonteil Thierry, Kellner James, Robinson Joan L
Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada.
J Matern Fetal Neonatal Med. 2012 Aug;25(8):1278-82. doi: 10.3109/14767058.2011.629249. Epub 2011 Nov 10.
Because neonatal herpes simplex virus (NHSV) infection is difficult to diagnose, there has been a move towards using more empiric acyclovir (ACV).
The purpose of this study was to review the use of ACV to optimize future management of NHSV.
Charts were reviewed for infants started on intravenous ACV up to day 43 of life--January 2001 through February 2007--at five hospitals in Edmonton and Calgary.
ACV was started for possible (N = 115) or proven (N = 3) herpes simplex virus (HSV) infection. Six of the infants with possible HSV infection later had proven HSV infection. Seizures (34%), hemodynamic instability (29%) and skin lesions (24%) were the most common indications for ACV. Among the 118 infants, 106 (90%) had cerebrospinal fluid obtained and 82 (69%) had at least one surface swab for HSV but 4 (3%) had no specimens submitted for HSV detection. ACV was continued for 3.9 ± 3.5 days in the infants with no proven HSV disease. Possible nephrotoxicity from ACV was recorded in 3 of these 109 infants and in none of the infants with proven HSV disease.
Clinicians in Alberta primarily consider the diagnosis of NHSV infection when confronted with a neonate with seizures, hemodynamic instability or suspicious skin lesions, but need to consider the diagnosis more often if all cases are to be treated at first presentation. They often perform incomplete investigations to rule out NHSV infection. Adverse events from ACV appear to be uncommon when the drug is used for suspected NHSV disease.
由于新生儿单纯疱疹病毒（NHSV）感染难以诊断，因此出现了更多使用经验性阿昔洛韦（ACV）的趋势。
本研究的目的是回顾阿昔洛韦的使用情况，以优化NHSV的未来管理。
回顾了2001年1月至2007年2月在埃德蒙顿和卡尔加里的五家医院中，出生后43天内开始静脉注射阿昔洛韦的婴儿的病历。
开始使用阿昔洛韦是为了治疗可能（n = 115）或已证实（n = 3）的单纯疱疹病毒（HSV）感染。115例可能感染HSV的婴儿中，有6例后来被证实感染了HSV。癫痫发作（34%）、血流动力学不稳定（29%）和皮肤病变（24%）是使用阿昔洛韦最常见的指征。在这118例婴儿中，106例（90%）进行了脑脊液检查，82例（69%）至少进行了一次HSV表面拭子检查，但4例（3%）未提交HSV检测标本。未证实患有HSV疾病的婴儿中，阿昔洛韦持续使用3.9±3.5天。这109例婴儿中有3例记录了阿昔洛韦可能的肾毒性，而确诊为HSV疾病的婴儿中无一例出现肾毒性。
艾伯塔省的临床医生在面对患有癫痫、血流动力学不稳定或可疑皮肤病变的新生儿时，主要考虑NHSV感染的诊断，但如果要在首次就诊时对所有病例进行治疗，则需要更频繁地考虑该诊断。他们经常进行不完整的检查以排除NHSV感染。当阿昔洛韦用于疑似NHSV疾病时，其不良事件似乎并不常见。
