2078. Adherence to Laboratory Screening Recommendations for Neonatal Herpes Simplex Virus Infection at a Tertiary Children’s Hospital

Abstract

BackgroundThough American Academy of Pediatrics (AAP) publications detail the precise laboratory evaluation to perform for suspected neonatal herpes simplex virus (HSV) infection, significant practice variability persists. The primary aim of this study was to assess adherence to AAP laboratory testing guidance for neonatal HSV at our hospital. Other aims included: (1) comparing adherence rates for infants tested due to concern for symptomatic infection with those screened due to maternal genital lesion presence at birth and (2) determining the rate of infected infants among those tested.MethodsChart review was performed for infants ≤42 days old hospitalized from February 1, 2013–June 30, 2016 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.ResultsOf 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).ConclusionAdherence 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.Disclosures All authors: No reported disclosures.