Pediatric Infectious Disease Fellow University of Florida College of Medicine Jacksonville, Florida, United States
Background: Neonatal herpes simplex virus (HSV) infection is a relatively rare but devastating disease. The American Academy of Pediatrics has guidelines for evaluation of neonatal HSV (2021-2024 Red Book). It includes HSV cultures and/or PCR of different sites including blood HSV PCR. Blood HSV PCR is not available in many hospitals and has to be sent to a reference lab, results are not available when decisions for starting, stopping or continuing acyclovir treatment are made. Usefulness of blood HSV PCR in the management of neonatal HSV infection is questionable. Objective: To determine the usefulness of blood HSV PCR in management of neonatal HSV infection. Design/Methods: A retrospective chart review of all neonates ( < 4 weeks of age) who had blood HSV PCR sent from 1/1/18 to 7/31/23 was done. Blood HSV PCR were sent to an outside reference lab; all other HSV PCR were done in house. Data gathered included: results of HSV PCR done from all sites, time from collection to availability of blood HSV PCR result, & if acyclovir was started, stopped or continued before blood HSV PCR results were available. Results: 164 total blood HSV PCR tests were done in neonates. 3 charts were not found & 12 charts did not have results documented. The remaining 149 charts were analyzed. It took a mean of 3.5 days (range: 3-4) for the blood PCR HSV reported positive and mean of 4 days (range 2-12) for negative results to be reported. 7 (4.7%) of 149 neonates had a positive blood HSV PCR & all of them had a positive HSV PCR from another site and acyclovir was started before the blood HSV PCR results were available. 6 (4%) of 142 neonates with negative blood HSV PCRs had a positive HSV PCR from another site and were treated accordingly. 2 neonates with negative blood and other sites HSV PCR were treated on clinical grounds. The decision to stop acyclovir was made after blood HSV PCR was reported negative in 12 (9.6%) of 136 patients. In other 122 neonates with negative blood HSV PCR, acyclovir was stopped before negative results were reported. However, HSV PCR from other sites were also negative in these neonates.
Conclusion(s): Blood HSV PCR testing in our institution did not impact the management of neonatal HSV infections. Blood HSV PCR (all negative) had an impact on decision to treat only in 12 (8%) of 149 neonates. All neonates with positive blood HSV PCR were treated without regard for the positive result. The blood HSV PCR test result had no impact on decision to stop treatment in 92% of the patients with negative blood HSV PCR. Our study does not support use of blood HSV PCR in the evaluation of neonatal HSV infection.
