Neonatal Herpes Simplex Virus Infections: New Data, Old Conundrum

* Abbreviations: HSV — : herpes simplex virus PCR — : polymerase chain reaction Infections with herpes simplex virus (HSV) in the neonatal period represent an ongoing challenge for practicing clinicians. Neonatal HSV has a high risk of mortality and significant neurologic disability among survivors, and timely initiation of treatment with acyclovir is needed to impact outcomes.1 Treatment delays of even 1 day have been associated with a greater than twofold increase in odds of mortality, yet these infections can be subtle on presentation and therefore difficult to identify expeditiously.2–4 Furthermore, there is an added layer of complexity, which stems from increasing evidence that strategies of excessive testing and empirical treatment among infants without HSV are costly and increase the risk of adverse events, including medication error, intravenous line complications and/or infiltration, and disruption of breastfeeding (acyclovir itself is generally safe in neonates).5–8 In this issue of Pediatrics , Mahant et al9 provide a retrospective assessment of the epidemiology of neonatal HSV in a large Medicaid population and demonstrate an increase in incidence over a 7-year period. They further demonstrate a high financial burden in these patients, including … Address correspondence to James Gaensbauer, MD, MScPH, Department of Pediatrics, Denver Health Medical Center, 777 Bannock St Pavilion C, MC 0590, Denver, CO 80204. E-mail: james.gaensbauer{at}childrenscolorado.org