Neonatology Book

Miscellaneous

Viral Infection

  • Neonatal Herpes Simplex Virus

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Neonatal Herpes Simplex VirusAka: Neonatal HSV

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  1. See Also
    1. Genital Herpes
    2. Neonatal Sepsis
  2. Epidemiology
    1. Incidence: 1 per 3,000 to 20,000 live U.S. births
    2. Prevalence of HSV II seropositivity in U.S. adults: 25%
    3. HSV seroconversion during pregnancy: 2-3%
  3. Pathophysiology
    1. Vertical transmission from mother
      1. Vaginal delivery with active Genital Herpes lesions
    2. Highest risk if primary HSV outbreak in third trimester
      1. Risk of transmission during primary HSV outbreak: 33%
      2. Risk of transmission during secondary HSV: 3%
    3. Many women are asymptomatic
      1. In known neonatal HSV, only 30% mothers symptomatic
  4. Risk Factors
    1. Maternal HSV at time of delivery (highest risk)
      1. HSV is asymptomatic in nearly two thirds of mothers
      2. Exercise a low clinical threshold for testing
    2. Fetal scalp electrode use
    3. Vaginal delivery
  5. Symptoms
    1. Irritability
    2. Fever
    3. Lethargy
    4. Poor feeding
  6. Signs: Perinatal Transmission
    1. Skin HSV lesions absent in 50% of disseminated cases
    2. Eye or mouth HSV vesicular lesions
    3. Encephalitis
    4. Other disseminated HSV infection sites
      1. Lung
      2. Liver
      3. Adrenal glands
  7. Signs: Congenital HSV Infection (in utero transmission)
    1. Microcephaly
    2. Hydrocephalus
    3. Chorioretinitis
    4. Hepatomegaly
      1. Helps differentiate from Erythema Toxicum Neonatorum
  8. Labs: Culture sites (repeat weekly)
    1. Culture vesicular fluid for HSV
      1. Culture any vesicular rash in infant under 2 months
    2. Blood Culture for HSV
    3. Urine Culture for HSV
    4. CSF Culture and PCR for HSV
    5. HSV Culture of fluid from Eyes, nose and mucosa
    6. Liver transaminases (ALT, AST)
  9. Management
    1. Consider rule-out Neonatal Sepsis protocol concurrently
    2. Acyclovir 60 mg/kg/day IV divided q8 hours
      1. Kimberlin (2001) Pediatrics 108(2):230
    3. Duration of antiviral therapy
      1. Local involvement (e.g. eyes): 14 days
      2. Disseminated or CNS involvement
  10. Complications
    1. Neonatal Seizure disorder
    2. Psychomotor retardation
    3. Spasticity
    4. Learning Disability
    5. Blindness
  11. Prognosis: Mortality
    1. Localized (Skin, eyes, mouth): No increased mortality
    2. HSV Encephalitis: 15% mortality
    3. Disseminated HSV: 57% mortality
  12. References
    1. Kohl in Behrman (2000) Nelson Pediatrics, p. 966-72
    2. Kimberlin (2001) Pediatrics 108(2):223
    3. Rudnick (2002) Am Fam Physician 65(6):1338

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