26 Use of acyclovir in infants aged less than six weeks at a Canadian tertiary care centre: too much or too little?
Notice bibliographique
Résumé
Herpes simplex virus (HSV) infection carries major morbidity and mortality in the neonatal period. HSV infection in neonates may present with multiple clinical presentations, including localized skin, eye, and mouth (SEM), central nervous system (CNS) or disseminated disease. Current practices are not standardized regarding when to initiate treatment for suspected HSV infection as opposed to guidelines that exist on the management of the febrile infants. Previous research has shown that Canadian pediatric emergency physicians rarely empirically administer acyclovir to febrile neonates without risk factors. In contrast, some American pediatric hospitals strongly recommend considering acyclovir in all febrile neonates less than 21 days of age. The Canadian Paediatric Society (CPS) supports that infants up to 42 days of age should be fully evaluated for HSV when clinical features are consistent with such infection. The primary aim of this study was to describe current practices in the use of acyclovir in infants less than six weeks of age at a tertiary Canadian pediatric hospital. Secondary aims were to assess the prevalence of HSV infection in this cohort as well as the diagnostic work-up performed and the therapeutic management of those patients. We performed a retrospective observational cohort study of infants aged less than six weeks of age who were treated with acyclovir based on fever and/or clinical symptoms suggestive of possible HSV infection (such as seizure, shock, cutaneous vesicles or neonatal conjunctivitis). All infants were evaluated by a pediatrician in a single pediatric tertiary care centre between January 1st 2015 and December 31st 2017. Infants were admitted under general pediatrics or in the neonatal or pediatric intensive care unit. Chart review was performed and multiples variables were included in the analysis. Patients with insufficient chart data, already hospitalized at the time of acyclovir initiation or transferred to another hospital prior to discharge were excluded. 109 patients were included. Most patients were born by vaginal delivery (84%) and without instrument assistance (85%). Most pregnant women (97%) had no history of HSV. At the time of presentation in the emergency department, the mean age was 20 ± 11 days. Most patients presented with fever (64%) while only three presented with cutaneous vesicles. 62 patients (57%) received intravenous fluid bolus therapy. All patients were admitted, with a mean hospital stay of 5.2 ± 4.5 days. Patients were treated with acyclovir for 2.1 ± 2.2 days. Most patients had a baseline CBC (n=108), C-reactive protein (n=98), creatinine (n=96) and ALT (n=67) levels. With regards to investigations for HSV, 103 patients (94%) had a lumbar puncture (LP) with cerebrospinal fluid (CSF) HSV PCR (n=100) or viral culture (n=66). Only 12 patients underwent skin or mucous membrane swab and 14 blood HSV PCR. A minority of patients with an elevated ALT level on admission had a blood HSV PCR. Among all, only two patients had a confirmed HSV infection, one with isolated ocular involvement (keratitis) and the other with SEM and disseminated infection. Both had family members with HSV, the latter with confirmed maternal postnatal primary infection. Both patients were afebrile at presentation. Only two patients were found with HSV infection. Both were afebrile and had family members with active lesions. Despite neonatal HSV presenting with three clinical forms, most clinicians relied on CSF alone to rule out HSV infection, even with a normal LP. A limited number of patients underwent blood PCR or swabs of mucous membranes, even in cases of elevated serum transaminases. Fever alone as a screening symptom for HSV infection appears to be insufficient. Further research is needed to define optimal management.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».