Neonatal herpes simplex virus infection: follow-up evaluation of vidarabine therapy.
Neonatal herpes simplex virus infection: follow-up evaluation of vidarabine therapy.
复制标题
新生儿单纯疱疹病毒感染：阿糖腺苷治疗的随访评估。
作者：
R. Whitley;A. Yeager;P. Kartus;Y. Bryson;J. Connor;C. Alford;A. Nahmias;S. Soong
进行阿糖腺苷（阿糖腺苷）治疗的开放性研究，以验证新生儿单纯疱疹病毒感染的死亡率，并进一步确定长期发病率。共有39名先前未报告的婴儿接受了15 mg/kg/d（16名新生儿）或30 mg/kg/d（23名新生儿）阿糖腺苷静脉给药10至14天。将结果与之前试验中评估的56名新生儿的结果进行比较。无论药物剂量如何，治疗使患有播散性和CNS疾病的婴儿的死亡率降低至40%。器官受累的程度，特别是单纯疱疹病毒肺部感染是死亡率的预测因素（P = 0.001）。对于这些婴儿，32%在治疗后2年达到正常发育里程碑。皮肤、眼睛和/或口腔局部疾病与死亡无关。然而，12%的治疗组新生儿发生神经功能缺损。这些发现强调了阿糖腺苷治疗新生儿单纯疱疹病毒感染的价值。然而，剂量增加似乎并未导致死亡率或发病率的显著改善。目前正在测试治疗模式的进一步改进和更有效的抗病毒药物的利用。
An open study of vidarabine (adenine arabinoside) therapy was performed to verify the mortality from neonatal herpes simplex virus infection and to define further long-term morbidity. A total of 39 babies not previously reported were treated with either 15 mg/kg/d (16 newborns) or 30 mg/kg/d (23 newborns) of vidarabine administered intravenously for ten to 14 days. Outcome was compared with that from 56 newborns evaluated in a prior trial. Irrespective of the dose of medication, therapy decreased the mortality in babies with disseminated and CNS disease to 40%. The extent of organ involvement and, in particular, pulmonary herpes simplex infection were predictive of mortality (P = .001, for both). For these babies, 32% achieved normal developmental milestones 2 years after therapy. Disease localized to the skin, eye, and/or mouth was not associated with death. However, neurologic impairment occurred in 12% of this treated group of newborns. These findings underscore the value of vidarabine therapy of neonatal herpes simplex virus infection. However, an increase in dosage did not appear to result in significant improvement in either mortality or morbidity. Further improvement in the mode of therapy and the utilization of more potent antiviral drugs are currently being tested.