HSV in the newborn
also see HSV

Etiology:

• HSV 1: Fever blisters, can cause genital herpes
• HSV 2: Genital herpes

Epidemiology:

• HSV 2 causes 75% of neonatal infections
• Vertical transmission: 33-50% transmission rate for primary infections; <5% for recurrences
• Postnatally, HSV 1 can be spread by close contact
   

Neonatal Herpes

Epidemiology

• 1/3000 to 1/20000 live births
• infection more likely in premature

Pathogenesis

• transmitted via passage through infected birth canal or by ascending infection
• >75% infected infants to mothers with no history or clinical findings of active HSV

Three Clinical Manifestations - may have clinical overlap of all three presentations; cases are equal in numbers

• Disseminated disease
  • Earliest onset (first week)
  • 1/3 of cases
  • Consider in neonate with sepsis, neg. bacterial Cx’s, severe liver dysfunction
  • multiple organs, especially liver and lungs
• Skin, Eye, Mouth disease (SEM) presents at about 11 days
• Localized CNS disease: Latest onset (second to third week; presents at 14-21 days)

Diagnosis

• Viral culture (#1)
• PCR

Treatment

• Acyclovir IV 60mg/kg/day div TID
• 14 days for SEM disease
• 21 days for disseminated or CNS disease
• Infants with ocular involvement should also receive a topical ophthalmic drug as well
• SEM disease best prognosis
• 25% pts with disseminated disease die despite tx

CHLA Board Review 2005