Clinical Utility of the Syndromic Meningitis/Encephalitis Molecular Panel in Neonates with Suspected Sepsis

Newborns are highly vulnerable to meningitis due to an immature blood-brain barrier. In cases of suspected clinical sepsis, empirical antibiotics are typically initiated after obtaining appropriate cultures when clinically indicated. This study aimed to evaluate the clinical utility of syndromic meningitis/encephalitis (sME) molecular panel testing in neonates with suspected sepsis, with a focus on its impact on clinical management and outcomes under selective versus routine testing strategies.

Data of 58 neonates hospitalized between January 2019 and August 2023 who underwent sME panel testing on cerebrospinal fluid (CSF) samples were retrospectively analyzed. The test was performed selectively in Period 1 (January 2019-October 2022) and routinely in Period 2 (October 2022-August 2023). Patient findings were compared between periods in terms of diagnostic stewardship principles.

The mean gestational age and birth weight were 36±4 weeks and 2,334±941 g, respectively. In Period 1, herpes simplex virus (HSV) was detected in two (7.4%) patients, and antiviral therapy was started. In Period 2, one case each of human herpesvirus 6 (HHV-6) and enterovirus was identified. The length of antibiotic treatment and hospital stay was similar between sME panel-positive (n=4) and -negative (n=54) patients during the study period (p=0.241 and p=0.890, respectively). No positive CSF cultures were found in any of the 58 neonates.

In neonates with suspected sepsis, sME panels may assist early identification of high-risk viral agents like HSV. However, given their cost and limited treatment impact without clear clinical indications, selective use based on clinical suspicion may offer a more appropriate and cost-effective approach.