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Legal Briefs: Could Herpes Meningocephalitis Have Been Prevented in this Infant?

A 14-day-old female infant born at term was brought to the pediatrician because her right eye was slightly swollen and had a watery discharge. The mother stated that she had an unremarkable pregnancy and vaginal delivery. The records reflected that the infant was healthy at the time of the 48-hour discharge. The physician concluded that a tear duct obstruction was present and asked the parents to massage it. The pediatrician retained by the plaintiff explained that an evaluation of the eye with cultures should have been done. The plaintiff explained that in the past, infants with Neisseria gonorrhoeae conjunctivitis presented at 2 to 5 days of age, but partial suppression by ocular prophylaxis has altered the onset to a later time. Chlamydia trachomatis conjunctivitis typically appears 5 to 14 days after birth. Herpes simplex virus (HSV) conjunctivitis was also an important infection to consider because of potentially devastating consequences if not recognized, especially with the eye being a common portal of entry and site of viral replication. The pediatrician retained by the defense disagreed and stated that it was not standard of care to perform a culture on the discharge, given this infant’s clinical findings .

Four days after the pediatrician visit, the mother brought her infant to the emergency department (ED) because of an elevated temperature of 100.5oF (38.1oC). The mother said that an aunt had a cold sore on her mouth when visiting the infant, but no other history of infection was noted at home and the mother again said that her pregnancy was unremarkable. In the ED, the infant’s temperature was 101.5oF (38.6oC). Except for an elevated heart rate of 175 beats/min and periorbital swelling of an erythematous right eye that had a watery discharge, the infant’s examination findings were normal. Two hours after arrival at the …