Herpes simplex testing in neonates in the emergency department

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Clinical Diagnostics

Background:

• Central nervous system (CNS) herpes simplex virus (HSV) infection poses a significant risk to neonates.
• Accurate and efficient diagnostic methods are crucial for timely intervention.

Purpose of the Study:

• To determine the prevalence of CNS HSV infection in neonates presenting to the emergency department.
• To identify factors influencing cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) testing.
• To evaluate the impact of an existing testing paradigm on testing frequency.

Main Methods:

• A nested case-control study involving neonates aged 0-28 days undergoing lumbar puncture in the emergency department.
• Multivariate logistic regression analysis to identify predictors of CSF HSV PCR testing.

Main Results:

• CSF HSV PCR testing was performed in 47% of neonates; CNS HSV infection prevalence was 0.5% (vs. 1.6% for bacterial meningitis).
• Testing was not associated with established HSV risk factors.
• Implementing a known HSV testing paradigm could reduce testing by 21% without missing cases.

Conclusions:

• HSV testing in neonates is common, disproportionate to the low prevalence of CNS HSV infection.
• Current CSF HSV PCR testing practices are not optimally aligned with known neonatal risk factors.
• Future strategies should integrate community HSV prevalence, neonatal risk factors, and clinical judgment for more targeted testing.