HERPES SIMPLEX, NEONATAL
By Gary M. White, MD
Courtesy Michael O. Murphy, MD
Herpes infection of the neonate may cause significant morbidity and mortality. The risk to the neonate is highest in cases where the mother acquired a primary infection of herpes simplex virus (HSV) in the third trimester.
- Approximately 1% of women are HSV culture-positive at term (recurrent herpes in the vast majority). Most are without symptoms or lesions.
- Ninety percent of pregnant women with genital HSV do not know they are infected.
- Sixty-seven percent of mothers with HSV-infected neonates deny ever having any symptoms of genital herpes prior to delivery. In most cases, maternal infection is asymptomatic or mild and infection is not recognized as HSV.
- The most common mode of transmission is intrapartum/natal at 85%. Intrauterine is rare at 5%. Postnatal, e.g., acquired from a relative, accounts for about 10% of cases.
- The mean onset of symptoms for skin, mouth, or eye lesions is 11 days postpartum (range: 3-20 days).
- CNS infection presents around 7-35 days (mean 17 days) of life and is associated with lethargy, seizures, temperature instability, poor feeding, irritability, tremors, and bulging fontanelle.
Localized herpes infection presents as a localized vesicular eruption without internal involvement. The skin, eyes, and mouth may be affected. The lesions frequently occur at site of presentation or trauma (e.g., scalp electrode, forceps, etc.). As a general rule, the vesicles of bullous impetigo are more fragile and break easier than those of herpes simplex.
The infection may disseminate, affecting the internal organs, e.g., hepatitis, pneumonitis. CNS herpes is a serious infection of the brain. Signs include lethargy, tremors, and seizures.
A multidisciplinary approach is necessary. For full management and treatment, see other resources. In general, newborns who possibly have herpes infection should be isolated and treated empirically with intravenous antiviral therapy (acyclovir 30-60 mg/kg daily). Eye exam is important along with evaluation for systemic involvement.
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