Viral Polymerase Chain Reaction Testing of the Cerebrospinal Fluid: Comprehensive Care for Neonates With a Fever

Neonates who develop fever have a high risk for serious infection, and while the standard of care involves performing a full sepsis evaluation, current guidelines do not include viral polymerase chain reaction (PCR) testing of the cerebrospinal fluid as a standard of care, which means that cases of viral meningitis can be missed. This case presentation discusses a neonate who had a fever at four days of life who then underwent a full sepsis evaluation. A respiratory viral panel demonstrated rhino/enterovirus positivity. A lumbar puncture was consistent with aseptic meningitis and newborn was prophylactically covered with acyclovir until the cerebrospinal fluid PCR confirmed enterovirus positivity and was negative for herpes simplex virus. The neonate experienced thrombocytosis and elevated transaminase levels, which resolved before discharge. Acyclovir was discontinued following a pediatric infectious disease consultation. The patient steadily improved, passed all screenings, and was discharged on day 16 with follow-up appointments arranged, including developmental pediatrics and repeat hearing screenings. Despite the viral panel indicating a respiratory virus, the presence of a respiratory virus in a neonate does not necessarily reduce the risk of a serious bacterial illness, especially in infants younger than 29 days. Viral meningitis can be associated with substantial complications and, so viral PCR testing of the cerebrospinal fluid allows clinicians to monitor for the development of severe disease and set up outpatient follow-ups for potential long-term sequelae of viral meningitis, such as neurodevelopmental delays.