SHM Converge Scientific Abstract ePoster Gallery-Neonatal HSV Exposure: A Call to Prevent Unnecessary Interventions

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This document discusses management of infants at risk for neonatal herpes simplex virus (HSV) infection, emphasizing that decisions are often based on clinician judgment because no randomized controlled trials exist. Current American Academy of Pediatrics (AAP) guidance uses factors such as maternal history of genital HSV, maternal serology, whether infection is primary or recurrent, and whether the newborn has symptoms to determine the extent of evaluation and whether empiric acyclovir should be started.<br /><br />The case data show largely negative infectious testing. Blood HSV PCR was not detected, blood culture showed no growth, and cerebrospinal fluid (CSF) HSV PCR and meningitis/encephalitis panel were negative. CSF culture was also negative, and skin HSV culture found no HSV isolated. CSF values showed elevated red blood cells and protein, with mildly increased white blood cells, but these findings did not confirm HSV.<br /><br />The discussion highlights a gap in existing guidelines: they do not clearly address infants who were asymptomatic but not fully evaluated in the nursery and later require readmission. In such situations, clinicians must balance the risk of missing neonatal HSV—which can be severe—with the risks of unnecessary testing, treatment, and hospitalization.<br /><br />The document also notes efforts to improve risk stratification, including studies identifying predictors of invasive HSV infection and development of an HSV Risk Score. It concludes that strict adherence to newborn HSV evaluation guidelines is important to avoid unnecessary future interventions, and that further research into risk scores and management strategies may help reduce hospitalizations and healthcare costs while improving safety.

Asset Subtitle

Ally Watson

Meta Tag

Author List Ally Watson, Tova Appleson

Category Clinical Vignettes

Concept Herpes Simplex Virus Infection

Concept Asymptomatic Neonate

Concept Empiric Acyclovir Therapy

Concept Cerebrospinal Fluid

Concept American Academy of Pediatrics

Distinguished Non-Finalist

Presenter Organization Hackensack University Medical Center

Presenting Author Ally Watson

Track Pediatric

Keywords

neonatal herpes simplex virus

HSV infection

AAP guidelines

empiric acyclovir

maternal genital HSV

HSV PCR

cerebrospinal fluid

risk stratification

infant readmission

infectious testing

Herpes Simplex Virus Infection

Asymptomatic Neonate

Empiric Acyclovir Therapy

Cerebrospinal Fluid

American Academy of Pediatrics