Neonatal Herpes

Neonatal herpes, also known as neonatal herpes simplex, is a rare but serious infection that occurs when a newborn baby is exposed to the herpes simplex virus (HSV) during delivery or shortly after birth.

Causes and Risk Factors

The primary cause of neonatal herpes is the transmission of HSV from an infected mother to her baby during vaginal delivery. The risk factors for neonatal herpes include:

• Mother has a history of genital herpes or is experiencing an active outbreak at the time of delivery
• First-time infection with HSV during pregnancy, especially in the third trimester
• Premature birth
• Prolonged rupture of membranes
• Use of fetal scalp electrodes during labor

Symptoms

The symptoms of neonatal herpes can vary depending on the severity of the infection and may include:

• Skin, eye, or mouth lesions (blisters or sores)
• Fever
• Irritability or lethargy
• Poor feeding
• Seizures
• Respiratory distress

Types of Neonatal Herpes

There are three main types of neonatal herpes:

• Skin, Eye, and Mouth (SEM) Disease: This is the most common form of neonatal herpes, accounting for about 45% of cases. It typically presents with skin lesions, conjunctivitis, or oral mucosal lesions.
• Central Nervous System (CNS) Disease: This type accounts for about 30% of cases and can present with symptoms such as seizures, lethargy, and irritability. CNS disease can lead to long-term neurological damage or developmental delays.
• Disseminated Disease: This is the most severe form of neonatal herpes, accounting for about 25% of cases. It can affect multiple organs, including the lungs, liver, and brain, and has a high mortality rate if left untreated.

Diagnosis

Diagnosing neonatal herpes can be challenging, but it typically involves:

• Physical examination and medical history
• Viral culture or PCR (polymerase chain reaction) testing of skin lesions or other bodily fluids
• Serologic tests to detect HSV antibodies in the mother's blood

Treatment

Treatment for neonatal herpes typically involves antiviral medication, such as acyclovir, which is administered intravenously. The goal of treatment is to reduce the severity of symptoms, prevent long-term complications, and minimize the risk of mortality.

Prevention

To reduce the risk of neonatal herpes, pregnant women with a history of genital herpes or those experiencing an active outbreak during pregnancy should:

• Inform their healthcare provider about their condition
• Receive antiviral medication during the last month of pregnancy to suppress viral shedding
• Consider a cesarean delivery if they are experiencing an active outbreak at the time of labor

Prognosis and Long-term Outcomes

The prognosis for neonatal herpes depends on the severity of the infection, the promptness and effectiveness of treatment, and the presence of any underlying medical conditions. With proper treatment, most babies with SEM disease or CNS disease can recover fully, while those with disseminated disease may experience long-term complications or developmental delays.