Febrile Infant: HSV Risk
HSV risk factors: Less than 46 Days Old
- Ill appearance - off guideline
- Prematurity: < 37 weeks EGA - off guideline
- Maternal history of genital HSV lesions
- Note: Most mothers of infants with HSV do not have known history of genital HSV
- Maternal fever from 48 hours before to 48 hours after delivery
- Vesicles or mucous membrane ulcers
- Seizure
- Hypothermia: < 36°C - off guideline
- CSF pleocytosis without positive Gram stain: WBC > 15/mm3
- Leukopenia: < 5,000/mm3
- Thrombocytopenia: < 150/mm3
- Elevated ALT (if obtained)
- Note: ALT elevation may be seen in disseminated disease, but is not a reliable marker for mucous membrane or CNS disease
HSV risk factors: 46-60 Days Old
- Vesicles or mucous membrane ulcers
- Risk of Neonatal HSV is highest in the first four weeks, and is rare at and beyond 46 days of life.
Pantell RH, Roberts KB, Adams WG, et al. Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics. 2021;148(2):e2021052228. doi:10.1542/peds.2021-052228.
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.