A 1-month-old infant recently discharged from the NICU after neonatal herpetic infection is on oral acyclovir. What action is appropriate for management?

A 1-month-old infant recently discharged from the NICU after neonatal herpetic infection is on oral acyclovir. What action is appropriate for management?

• A. Stop the oral acyclovir at 2 months of age.
• B. Perform routine skin cultures for herpes simplex virus.
• C. Obtain regular absolute neutrophil counts.
• D. Reinforce the need to give acyclovir indefinitely.

Answer: (C)

Neonates on long-term suppression therapy after neonatal herpes require ongoing safety monitoring for drug effects. Acyclovir can transiently affect the bone marrow, leading to neutropenia in some infants. Checking the absolute neutrophil count regularly helps detect this early so treatment can be adjusted if needed and the infant remains protected from relapse. Why this is best: Regular CBCs target a plausible medication-related risk in a vulnerable patient during extended therapy, balancing the benefit of ongoing suppression with the potential harm from neutropenia. Stopping therapy at a fixed early age isn’t appropriate because suppression is usually continued for several months to reduce relapse risk. Routine skin cultures aren’t part of ongoing management once the infection is treated, and continuing acyclovir indefinitely isn’t standard practice. Regular neutrophil monitoring gives actionable, patient-specific safety information during this course.

Neonates on long-term suppression therapy after neonatal herpes require ongoing safety monitoring for drug effects. Acyclovir can transiently affect the bone marrow, leading to neutropenia in some infants. Checking the absolute neutrophil count regularly helps detect this early so treatment can be adjusted if needed and the infant remains protected from relapse.

Why this is best: Regular CBCs target a plausible medication-related risk in a vulnerable patient during extended therapy, balancing the benefit of ongoing suppression with the potential harm from neutropenia. Stopping therapy at a fixed early age isn’t appropriate because suppression is usually continued for several months to reduce relapse risk. Routine skin cultures aren’t part of ongoing management once the infection is treated, and continuing acyclovir indefinitely isn’t standard practice. Regular neutrophil monitoring gives actionable, patient-specific safety information during this course.