UMEM Educational Pearls

Category: Pediatrics

Title: Neonatal Fever - Consider HSV

Keywords: Neonatal Fever, HSV, Acyclovir (PubMed Search)

Posted: 4/11/2008 by Sean Fox, MD (Updated: 4/13/2024)
Click here to contact Sean Fox, MD

Consider HSV

  • Consider HSV as an etiology of fever in a neonate (0-30days) even without a maternal history of HSV or h/o active lesions.
    • In one study, only 12% of neonates dx’d with HSV infections had mothers with a known h/o HSV or active lesions.
  • Start Acyclovir empirically in these neonates, especially if the Gram Stain is negative.  Send appropriate HSV PCR and Cx.
    • Only 29% of patients (pediatric and adult) ultimately diagnosed with HSV encephalitis were started on acyclovir in the ED. 
    • Those who were not started on acyclovir in the ED, had a significant delay of appropriate therapy.
    • If you don’t think of it… the admitting team might not either.


Whitley R, Davis EA, Suppapanya N. Incidence of neonatal herpes simplex virus infections in a managed-care population.  Sex Transm Dis. 2007 Sep;34(9):704-8.

Benson PC, Swadron SP. Empiric acyclovir is infrequently initiated in the emergency department to patients ultimately diagnosed with encephalitis.  Ann Emerg Med. 2006 Jan;47(1):100-5.  Epub 2005 Nov 8.