Causative agent:<unk> -1 or<unk> -2
Definition – “infection acquired peri-natally or postnatally without clinical manifestations at birth or in the first 24 hours of life but with subsequent clinical manifestations in the<unk>  period (age less than 29 days)” 
ED prevalence:
0.2% all neonates
0.3% febrile neonates
0.5% neonates undergoing LP
Prevalence similar to meningitis (0.4%) in neonates presenting for SBI workup 
Risk associated with age <3 weeks, primary maternal<unk>  infection at delivery
0.2% all neonates
0.3% febrile neonates
0.5% neonates undergoing LP
Whitney-Kimberlin disease categories
Disseminated (liver, lung, adrenal glands, skin, eye, brain) - 25%
2/3 have CNS involvement
CNS - 30%
SEM (skin, eye, mouth) - 45%
Conjunctival disease or minor skin lesions may be only manifestation
May go on to CNS, disseminated disease - workup and treat the same
Disseminated (liver, lung, adrenal glands, skin, eye, brain) - 25%
2/3 have CNS involvement
CNS - 30%
SEM (skin, eye, mouth) - 45%
Conjunctival disease or minor skin lesions may be only manifestation
May go on to CNS, disseminated disease - workup and treat the same
2/3 have CNS involvement
Conjunctival disease or minor skin lesions may be only manifestation
May go on to CNS, disseminated disease - workup and treat the same
May go on to CNS, disseminated disease - workup and treat the same
Not sensitive (maternal history of<unk> , nor specific (maternal fever, vaginal delivery, preterm birth) 
80% of mothers have no history of genital lesions 
Vesicular lesions most specific, present in <1/2 
Note: absence of vesicular rash does not rule out
May be well appearing - maintain high clinical suspicion
Ask about:
Temperature instability (fever, hypothermia)
Irritability
Lethargy
Seizures
Respiratory distress
80% of mothers have no history of genital lesions 
Note: absence of vesicular rash does not rule out
Temperature instability (fever, hypothermia)
Irritability
Lethargy
Seizures
Respiratory distress
Neonatal HSV
Upper respiratory infection 
Rubella
UTI
Smallpox
Sepsis
Syphilis
Meningitis