From the Neonatal Perinatal Medicine, Department of Pediatrics, Western University, London.
Division of Neonatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto.
Pediatr Infect Dis J. 2021 Jun 1;40(6):566-570. doi: 10.1097/INF.0000000000003071.
Neonates with disseminated neonatal herpes simplex virus infection often present with cardiorespiratory failure. The pathophysiological contributors to the disease phenotype, biologic mechanisms underlying the hemodynamic instability and optimal approach to cardiovascular treatment have not been well described. We describe clinical and echocardiography features of cardiovascular dysfunction, in a case series of neonates with disseminated herpes simplex virus, and response to physiology-based hemodynamic management. The biologic phenotype includes low systemic vascular resistance state, hypovolemia secondary to third space losses, myocardial dysfunction and pulmonary hypertension. Early targeted neonatal echocardiography provided hemodynamic insights on blood flow, shunt characterization, vascular resistance and cardiac function, that were difficult to gauge clinically (eg, differentiating parenchymal from pulmonary vascular disease) thereby positively impacted clinical care. All patients were stabilized hemodynamically without utilizing extracorporeal membrane oxygenation, although all patients died of multiorgan failure.
患有播散性新生儿单纯疱疹病毒感染的新生儿常出现心肺功能衰竭。导致疾病表型的病理生理因素、血流动力学不稳定的生物学机制以及心血管治疗的最佳方法尚未得到很好的描述。我们描述了一组播散性单纯疱疹病毒感染新生儿的心血管功能障碍的临床和超声心动图特征，以及对基于生理学的血流动力学管理的反应。生物学表型包括全身血管阻力低状态、第三间隙损失引起的血容量不足、心肌功能障碍和肺动脉高压。早期有针对性的新生儿超声心动图提供了血流、分流特征、血管阻力和心功能的血流动力学见解，这些在临床上难以评估（例如，区分实质与肺血管疾病），从而对临床护理产生了积极影响。所有患者均无需使用体外膜氧合即可稳定血流动力学，尽管所有患者均死于多器官衰竭。
