A Rare Case of Neonatal Disseminated Herpes Simplex Virus (HSV) With Concomitant Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia.

BACKGROUND: Neonatal herpes simplex virus (HSV) infections can be challenging to diagnose and often occur without maternal history of infection. Routine initial pharmacologic management when a neonate presents with signs of sepsis in the first weeks of life typically targets antibiotic therapies. This case illustrates the importance of the addition of antiviral coverage, especially when a neonate demonstrates temperature instability and neurologic changes. CLINICAL FINDINGS: This case report describes the unique presentation of a 9-day old neonate with clinical findings significant for sepsis. This neonate was diagnosed with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia with concomitant disseminated HSV-2 infection after presenting with temperature instability, lethargy, and signs of multisystem organ impairment. PRIMARY DIAGNOSIS: This neonate was diagnosed with disseminated HSV infection, which occurs in 25% of neonatal HSV disease. INTERVENTIONS: Treatment was initiated with high-dose intravenous acyclovir at 20 mg/kg/dose every 8 hours along with broad-spectrum antibiotics. Management should include anticipating and monitoring for progressive multisystem organ failure in bacterial or viral infection. OUTCOMES: This patient did not survive despite maximal intervention from the neonatal intensive care unit team. Disseminated HSV neonatal infections are associated with high mortality rates when they are present alone, and mortality is higher with concurrent bacteremia. PRACTICE RECOMMENDATIONS: Providers should have a high index of suspicion for HSV infection in neonates presenting in the first 1 to 3 weeks of life with signs of sepsis. Prophylactic treatment with high-dose acyclovir as an adjunct to broad-spectrum antibiotics while awaiting laboratory confirmation can be lifesaving.

Virtual Interprofessional Learning Due to COVID-19.

BACKGROUND: The COVID-19 pandemic necessitated sweeping changes in a neonatal nurse practitioner (NNP) program's approach to distance-accessible learning. Prioritizing student learning and safety, we developed a new alternative model for individualized simulation. METHOD: The scenario created for a student to deliver an unexpected diagnosis of trisomy 21, or Down syndrome, to a postpartum mother was redesigned to take place using web-conference technology. RESULTS: We successfully transitioned the planned in-person individualized simulation for NNP students delivering an unexpected diagnosis to a web-conference environment and added nurse-midwifery (NM) students. CONCLUSION: This simulation presented an authentic clinical situation encountered in practice, supporting the specialty-specific competencies for the NNP, NM, and core competencies for interprofessional collaborative practice. The web-conference platform is an effective strategy for simulation. Advanced practice nurses completing individualized simulation through technology are uniquely poised to leverage these skills as telemedicine increasingly influences their future clinical practice. [J Nurs Educ. 2021;60(6):346-351.].