What is Neonatal Herpes?
Neonatal herpes is a serious infection caused by the herpes simplex virus (HSV) that affects newborns. The virus can be transmitted from the mother to the baby during pregnancy, delivery, or after birth. There are two types of HSV: HSV-1 and HSV-2. Both types can cause neonatal herpes, though HSV-2 is more commonly associated with genital infections.
Intrauterine transmission: This is rare but can occur if the mother has a primary infection during pregnancy.
Perinatal transmission: The most common route, occurring during vaginal delivery if the mother has an active genital HSV infection.
Postnatal transmission: This can occur through direct contact with infected individuals or healthcare providers who have active herpes lesions.
Localized skin, eye, and mouth (SEM) disease: This form presents with vesicular lesions on the skin, eyes, or mouth.
Central nervous system (CNS) disease: Symptoms include seizures, lethargy, irritability, and poor feeding.
Disseminated disease: This severe form affects multiple organs, including the liver, lungs, and kidneys, leading to significant morbidity and mortality.
Clinical examination: Identifying characteristic vesicular lesions.
Laboratory tests: These include viral culture, polymerase chain reaction (PCR), and direct fluorescent antibody testing to detect HSV.
Lumbar puncture: This may be performed to evaluate for CNS involvement by analyzing cerebrospinal fluid (CSF) for HSV DNA.
Acyclovir: Administered intravenously, it is the most commonly used antiviral medication for treating neonatal herpes.
Supportive care: This includes managing symptoms like seizures and ensuring adequate nutrition and hydration.
Treatment duration varies depending on the type of disease:
SEM disease: Typically treated for 14 days.
CNS or disseminated disease: Usually requires 21 days of treatment.
What are the Long-term Outcomes?
The prognosis of neonatal herpes depends on the form of the disease and how quickly treatment is initiated. SEM disease generally has a good prognosis if treated early. CNS and disseminated diseases have higher risks of neurological impairment and mortality. Long-term follow-up is essential to monitor and manage potential complications.
Screening and treatment: Pregnant women with a history of HSV should be closely monitored, and antiviral prophylaxis may be recommended.
Cesarean delivery: This may be considered in women with active genital HSV lesions to reduce the risk of perinatal transmission.
Avoiding direct contact: Caregivers and healthcare providers with active herpes lesions should avoid direct contact with newborns.
Conclusion
Neonatal herpes is a critical condition in pediatrics that requires prompt diagnosis and treatment. Understanding the modes of transmission, clinical manifestations, and effective treatment strategies can significantly improve outcomes for affected newborns. Preventive measures are equally important in reducing the incidence of this potentially life-threatening infection.
