44 Viral Central Nervous System Infections in Canadian Infants <90 Days Old: Encephalitis as a Predictor of Neurodevelopmental Morbidity
Bibliographic record
Abstract
Herpes simplex virus (HSV) and enterovirus (EV) are important causes of central nervous system (CNS) infections in young infants. Though long-term morbidity has been linked to HSV, there is still limited data on outcomes of other viral CNS infections in young infants. 1) Conduct a descriptive analysis of viral CNS infections in infants <90 days old, 2) comparatively analyze outcomes of HSV and non-HSV CNS infections in neonates, and 3) determine predictors of neurodevelopmental morbidity and mortality following neonatal viral CNS infections. The Pediatric Investigators Collaborative Network on Infections in Canada’s database (January 2013-December 2014) was used to identify infants <90 days of age with proven viral CNS infection. Infants with seizures and/or abnormal head imaging suggesting parenchymal involvement were presumed to have encephalitis. There were 111 viral CNS infections comprising HSV (N=7; 6%), EV (N=103; 93%), and human parechovirus (N=1; 1%). Thirteen (12%) infants fulfilled criteria for encephalitis; 6 (86%) HSV and 7 (7%) EV. Infants with encephalitis were younger (median age 14 days (6–19 days) versus 25 days (14–33 days); p=0.012), more likely to require ICU admission (p<0.001) and more likely to have disseminated disease (p=0.007). Two (1.8%) infants died and 10 (9%) had neurodevelopmental morbidity. Death or neurodevelopmental morbidity was more likely in those with encephalitis compared to those without (8 (62%) versus 4 (4%); p<0.001)) and in infants with HSV compared to non-HSV (57% vs. 8%; p=0.002), but not any different between HSV and non-HSV encephalitis (p>0.05). Among infants <90 days of age with viral CNS infections, just over 10% have features consistent with encephalitis. These younger infants are also more likely to require ICU support and manifest extra-CNS disease. Although most infants with viral CNS infections have good outcomes, those with encephalitis, regardless of aetiology, should be identified as the ones requiring long-term neurodevelopmental follow-up.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".