title: Herpes simplex testing in neonates in the emergency department.
abstract: OBJECTIVE
  To determine the prevalence of central nervous system (CNS) herpes simplex virus (HSV) infection in neonates evaluated in the emergency department and to identify factors associated with cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) testing. An existing testing paradigm was then applied to determine its potential impact on testing frequency.
  
  
  METHODS
  This nested case-control study included infants aged 0 to 28 days who had lumbar puncture in the emergency department. Multivariate logistic regression was used to identify factors associated with CSF HSV PCR testing.
  
  
  RESULTS
  The CSF HSV PCR testing was performed in 266 (47%) of 570 neonates. The prevalence of CNS HSV infection was 0.5% compared with 1.6% for bacterial meningitis. Performance of CSF HSV PCR testing was not associated with known HSV risk factors. Application of a known HSV testing paradigm would have reduced the proportion of infants tested by 21% without missing any of the cases of CNS HSV infection.
  
  
  CONCLUSIONS
  The HSV testing remains common despite the low prevalence of HSV infection. The CSF HSV PCR testing is not well aligned with known risk factors. Future testing strategies should incorporate community HSV prevalence, known neonatal risk factors, and clinical judgment.
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA. mcguirej@email.chop.edu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: McGuire
authors.forename: Joseph
authors.initials: J
authors.lastname: Zorc
authors.forename: Daniel
authors.initials: D
authors.lastname: Licht
authors.forename: Richard L
authors.initials: RL
authors.lastname: Hodinka
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D002555:Cerebrospinal Fluid / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis*; D003937:Diagnosis, Differential; D005260:Female; D006561:Herpes Simplex / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018139:Simplexvirus / Q000235:genetics*; D013129:Spinal Puncture
chemical_list: D004279:DNA, Viral