Methods: Chart review was performed for infants ≤ 42 days old hospitalized from 2/1/13 – 6/30/16 and tested for HSV. Subjects were categorized as asymptomatic neonates born to mothers with active genital HSV lesions at delivery or as symptomatic with concern for neonatal HSV disease. Those tested as outpatients and asymptomatic newborns of mothers with a history of genital HSV but no active lesions at delivery were excluded. Demographics and maternal HSV status were collected. Evaluations were classified as complete or incomplete based on AAP recommendations.
Results: Of 245 subjects, 24 (10%) were asymptomatic newborns of mothers with lesions at delivery, while 221 (90%) were tested due to possible symptomatic disease. Only 4/245 (1.6%) had HSV infection. Complete evaluations were more likely for asymptomatic infants (p<0.01), but only 27 total subjects (11%) had a complete evaluation. Blood PCR and surface cultures were omitted most frequently - missing from 196 (80%) and 150 (61%) evaluations, respectively. Of those lacking surface cultures, 58 (39%) had surface PCRs. CSF PCRs were not obtained for 118/221 (53%) symptomatic evaluations. No association was found between known maternal history of genital HSV prior to delivery and evaluation completeness (p=0.19).
Conclusion: Adherence to AAP testing recommendations for neonatal HSV was poor, though evaluation completeness was more likely for asymptomatic infants of mothers with lesions at delivery than for symptomatic infants. Despite a low incidence of neonatal HSV, education regarding appropriate laboratory testing is needed. Bundling computerized electronic orders for testing may improve adherence.
J. M. Klatte, None