Key result
Early targeted neonatal echocardiography guided physiology-based management to stabilize all patients hemodynamically without ECMO, although all ultimately died of multiorgan failure.
Why the study?
The pathophysiological contributors, biological mechanisms underlying hemodynamic instability, and optimal cardiovascular treatment in neonates with disseminated herpes simplex virus and cardiorespiratory failure are not well described.
Case Report
Targeted neonatal echocardiography provides critical hemodynamic insights that can guide successful cardiovascular stabilization in neonates with disseminated HSV, though overall mortality from multiorgan failure remains high.
Stabilization without ECMO did not prevent multiorgan failure deaths; leaves open targeted neonatal echocardiography utility pending prospective validation.
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.
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Bhattacharya et al. (2021) conducted a case report in Disseminated neonatal herpes simplex virus infection. Targeted neonatal echocardiography and physiology-based hemodynamic management was evaluated on Hemodynamic stabilization and mortality. Early targeted neonatal echocardiography guided physiology-based management to stabilize all patients hemodynamically without ECMO, although all ultimately died of multiorgan failure.
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