By Gary M. White, MD

Neonatal Herpes Simplex 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.


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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