Identifying Infants at Low Risk for Neonatal Herpes Simplex Virus Infection.

Area of Science:

• Neonatalogy
• Infectious Diseases
• Pediatric Critical Care

Background:

• Neonatal herpes simplex virus (HSV) infection, though rare, carries significant morbidity.
• Current guidelines suggest evaluating infants for HSV based on specific risk factors during sepsis workups.
• Limited data exist on the effectiveness of these risk factors in identifying infants with neonatal HSV.

Purpose of the Study:

• To identify low-risk infants for neonatal HSV infection among those undergoing sepsis evaluations.
• To assess the value of specific clinical and laboratory criteria in stratifying risk for neonatal HSV.

Main Methods:

• A retrospective case-control study included infants up to 42 days old evaluated for sepsis.
• Firth logistic regression analyzed the odds of high-risk criteria (skin vesicles, seizures, elevated ALT, thrombocytopenia, CSF pleocytosis, critical illness) in infants with and without HSV.
• Cases were matched with controls (infants without HSV) admitted within 45 days.

Main Results:

• Thirty-two cases of neonatal HSV and 128 controls were identified.
• Infants without HSV showed a significantly lower prevalence of seizures, skin lesions, CSF pleocytosis, elevated ALT, thrombocytopenia, and critical illness.
• The adjusted odds ratio for controls having at least one risk factor was substantially lower than for cases (0.07 and 0.02 for control groups A and B, respectively).

Conclusions:

• Infants presenting for sepsis evaluation without HSV infection are unlikely to exhibit key high-risk criteria.
• The absence of seizures, skin lesions, elevated ALT, thrombocytopenia, CSF pleocytosis, or critical illness suggests a lower risk for neonatal HSV.
• These findings can guide targeted evaluations, potentially reducing unnecessary testing and treatment in low-risk infants.