Methods: A retrospective chart review was performed on infants less than 90 days of life started on acyclovir from April 2014-April 2015. Extracted data were compared with suggested management of HSV to determine appropriateness of therapy. References included the Byington et al care process model (CPM) for febrile infants, as well as the Kimberlin et al clinical guidance for infants born to mothers with HSV.
Results: A total of 70 records were reviewed. Of these, 39 (55.7%) were male and 31 (44.3%) were female. Patient location during acyclovir initiation included: Neonatal Intensive Care Unit (48.6%), Pediatric Intensive Care Unit (17.1%), Pediatric Acute Care Unit (17.1%), Pediatric Emergency Department (15.7%) and Newborn Nursery (1.4%). Fever or hypothermia was present in 27 (39%) of treated infants. Eighteen infants (25.7%) presented with seizures, only four of whom had an abnormal temperature. Three infants (4.3%) presented with vesicular lesions; none of these infants were febrile. Only three infants (4.3%) had positive HSV testing. One infant died from hemorrhagic HSV meningoencephalitis, one had HSV-2 viremia, and one had mucocutaneous involvement.
Sixteen infants (22.9%) met guidelines for treatment for HSV as outlined by the CPM by Byington et al, but 15 out of 16 of these infants had incomplete testing (i.e. missing liver function testing, serum HSV PCR, surface swabs for HSV PCR or cerebrospinal fluid testing).
Acyclovir was initiated for seven infants (10%) because of a maternal history of HSV infection. Two of these infants had positive testing.
Conclusion: This retrospective chart review validates the Care Process Model created by Byington et al and the clinical guidelines by Kimberlin et al by identifying the three of 70 infants with positive HSV testing. These criteria also accurately screened out infants in whom testing was not warranted. Future efforts will focus on education of staff to reduce the use of empiric acyclovir in low-risk neonates.
C. Falato, None
R. Jhaveri, None