- Overview of Infections in Newborns
- Sepsis in Newborns
- Hospital-Acquired Infections in Newborns
- Pneumonia in Newborns
- Bacterial Meningitis in Newborns
- Listeriosis in Newborns
- Conjunctivitis in Newborns
- Herpes Simplex Virus (HSV) Infection in Newborns
- Hepatitis B Virus (HBV) Infection in Newborns
- Cytomegalovirus (CMV) Infection in Newborns
- Rubella in Newborns
- Syphilis in Newborns
- Toxoplasmosis in Newborns
- Tuberculosis (TB) in Newborns
Herpes simplex virus infection usually causes only annoying, recurring blisters in healthy adults but can cause severe infection in newborns.
Newborns may become infected during delivery or after birth.
The main symptom is a rash of blisters.
The diagnosis is typically based on tests of samples taken from the blisters.
Newborns with herpes simplex virus infection are given the antiviral medication acyclovir.Newborns with herpes simplex virus infection are given the antiviral medication acyclovir.
This infection is fatal in many untreated children.
To prevent spreading the infection, infected pregnant people may be given antiviral medications at the end of pregnancy and may have a cesarean delivery (c-section).
(See also Overview of Infections in Newborns and Herpes Simplex Virus Infections in adults.)
Infection with herpes simplex virus (HSV) is very common in adults. The virus can be transmitted sexually and cause infection of the genital tract. The virus never goes completely away and remains dormant (inactive) in various tissues for life. Sometimes the virus reactivates (becomes active).
Usually, HSV infection is transmitted during delivery through infection in the mother's vagina or vulva (labia). Even infected mothers who do not have any symptoms of herpes can still transmit the infection. Sometimes newborns become infected after birth when they come in contact with someone who has an active infection, such as a family member.
In newborns, HSV infection can lead to chronic health problems or even be fatal.
Symptoms of HSV Infection in Newborns
Symptoms of herpes simplex virus infection usually start between the first and third weeks of life but rarely may not appear until the fourth week. The first symptom is usually a rash of small, fluid-filled blisters. The blisters can also appear inside the mouth and around the eyes.
This close-up of a newborn's mouth shows sores on and under the upper lip caused by herpes simplex virus.
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
This photo shows a newborn who has advanced HIV infection (also called acquired immunodeficiency syndrome [AIDS]) and a rash of small fluid-filled blisters covering the entire body. The blisters are caused by herpes simplex virus.
DR M.A. ANSARY/SCIENCE PHOTO LIBRARY
This photo shows small, fluid-filled blisters on the face of a newborn infected with herpes simplex virus.
By permission of the publisher. From Demmler G: Congenital and perinatal infections. In Atlas of Infectious Diseases: Pediatric Infectious Diseases. Edited by CM Wilfert. Philadelphia, Current Medicine, 1998.
This close-up of a newborn's mouth shows sores on and under the upper lip caused by herpes simplex virus.
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
This photo shows a newborn who has advanced HIV infection (also called acquired immunodeficiency syndrome [AIDS]) and a rash of small fluid-filled blisters covering the entire body. The blisters are caused by herpes simplex virus.
DR M.A. ANSARY/SCIENCE PHOTO LIBRARY
This photo shows small, fluid-filled blisters on the face of a newborn infected with herpes simplex virus.
By permission of the publisher. From Demmler G: Congenital and perinatal infections. In Atlas of Infectious Diseases: Pediatric Infectious Diseases. Edited by CM Wilfert. Philadelphia, Current Medicine, 1998.
In some newborns, the infection affects only certain areas (localized). For example, the infection may involve only the eyes, skin, and mouth. Sometimes, only the brain and nervous system are affected. If a localized infection is not treated, some newborns develop a widespread infection.
A widespread infection affects many areas. In affected infants, organs such as the eyes, lungs, liver, brain, and skin are all infected. Symptoms include sluggishness, diminished muscle tone, breathing problems, pauses in breathing (apnea), and seizures.
Diagnosis of HSV Infection in Newborns
Testing of a sample taken from blisters and other body fluids
To diagnose herpes simplex virus infection, doctors take samples of material from the blisters and other body fluids and send the samples to a laboratory to grow (culture) the virus and identify the herpes simplex virus. Doctors may also do the polymerase chain reaction (PCR) test on the samples. This test looks for the genetic material of the virus, which enables doctors to rapidly identify it.
If doctors suspect the newborn has a brain infection, a spinal tap (lumbar puncture—see figure How a Spinal Tap Is Done) to obtain a sample of spinal fluid may be done.
Treatment of HSV Infection in Newborns
AcyclovirAcyclovir
Newborns who have a widespread infection are given the antiviral medication acyclovir by vein (intravenously) for 3 weeks and then by mouth for 6 months. Newborns who have a localized infection are given acyclovir intravenously for 2 weeks. This medication does not cure the infection but helps keep it from spreading and limits the symptoms.
Eye infections also are treated with eye drops that contain another antiviral medication called trifluridine or with an eye gel that contains another antiviral medication called ganciclovir.Eye infections also are treated with eye drops that contain another antiviral medication called trifluridine or with an eye gel that contains another antiviral medication called ganciclovir.
Additional care, such as fluids and breathing support, is provided as needed. All infants with herpes simplex virus infection should have an eye examination and imaging tests of the brain.
Prognosis for HSV Infection in Newborns
If herpes simplex virus infection of the newborn is not treated, it usually progresses to severe problems. The infection is fatal in approximately 85% of babies with untreated widespread infection and in approximately 50% of newborns with untreated brain infection. Without treatment, at least 65% of survivors of widespread disease or brain infection have severe neurologic problems. Even with treatment, newborns with widespread infection or brain infections may have neurologic or developmental problems.
Severe infection is not common among newborns whose infection is limited to the skin, eyes, or mouth. However, without treatment, many of these newborns develop widespread infection or brain infection.
Appropriate treatment with antiviral medications decreases the fatality rate and significantly increases the likelihood of normal development.
Prevention of HSV Infection in Newborns
If pregnant people have had a genital herpes infection in the past, it is recommended that they start taking an antiviral medication (acyclovir or valacyclovir) starting at 36 weeks of pregnancy.If pregnant people have had a genital herpes infection in the past, it is recommended that they start taking an antiviral medication (acyclovir or valacyclovir) starting at 36 weeks of pregnancy.
If pregnant people have active genital herpes lesions or symptoms that indicate the infection is going to become active (such as tingling, discomfort, or itching) at the time of delivery, cesarean delivery (c-section) is recommended to decrease the risk of transmitting the infection to the newborn.
Newborns who are born to people who have an active herpes infection at the time of a vaginal delivery should be tested for herpes simplex virus infection.
