Impact of congenital anomalies and treatment location on the outcomes of infants hospitalized with herpes simplex virus (HSV).

ABSTRACT

BACKGROUND: Herpes simplex virus (HSV) is a rare but costly reason for hospitalization in infants under 60 days of age. The impact of coexisting comorbid conditions and treatment location on hospital outcome is poorly understood. OBJECTIVE: Determine patient and hospital factors associated with poor outcomes or death in infants hospitalized with HSV. DESIGN: Retrospective cohort study using the 2003 Kids' Inpatient Database (KID). SETTING: U.S. hospitals. PATIENTS Infants under 60 days of age with a diagnosis of HSV. INTERVENTION Treatment at different types of hospitals, younger age at admission, and presence of congenital anomalies. MEASUREMENTS Serious complications, in-hospital death. RESULTS: A total of 10% of the 1587 identified HSV hospitalizations had a concurrent congenital anomaly. A total of 267 infants had a serious complication and 50 died. After controlling for clinical and hospital characteristics, concurrent congenital anomalies were associated with higher odds of a serious complication (adjusted odds ratio [OR], 3.34; 95% confidence interval [CI], 2.00-5.56) and higher odds of death (adjusted OR, 4.17; 95% CI, 1.74-10.0). Similar results were found for infants admitted under 7 days of age. Although different hospital types had statistically similar clinical outcomes after controlling for case-mix differences, treatment at a children's hospital was associated with an 18% reduction in length of stay (LOS). CONCLUSIONS: Infants with concurrent congenital anomalies infected with HSV were at increased risk for serious complications or death. Health resource use may be improved through identification and adoption of care practiced at children's hospitals.