Birth-acquired herpes

• Alternative Names

  HSV; Congenital herpes; Herpes - congenital

• Causes, incidence, and risk factors

  Newborn infants can become infected with herpes virus:

  • In the uterus (intrauterine herpes -- this is very rare)
  • Passing through the birth canal (birth-acquired herpes, the most common method of infection)
  • Right after birth (postpartum)

  If the mother has an active genital herpes infection at the time of delivery, the baby is more likely to become infected during birth. Some mothers are not aware when they have internal (inside the vagina) herpes sores, so it is important for women to tell their doctor if they have a history of genital herpes.

  In addition, some people have had herpes infections in the past, but were not aware of it and were never diagnosed or treated. These people, not knowing that they have herpes, may pass it to their baby. Herpes type 2 (genital herpes) is the most common cause of herpes infection in newborn babies, but herpes type 1 (oral herpes) can also occur.

• Symptoms

  Intrauterine herpes can cause:

  • Eye disease, such as inflammation of the retina (chorioretinitis)
  • Severe brain damage
  • Skin lesions

  Birth-acquired herpes can produce localized (in one area of the body) or systemic (throughout the body) disease. Infants may develop only a localized skin infection consisting of small fluid-filled blisters (vesicles) that rupture, crust over, and finally heal, often leaving a mild scar.

  A second type of birth-acquired herpes infection leads to encephalitis, an inflammation of the brain that can result in seizures and later brain and nervous system (neurologic) problems. If untreated, it may lead to death.

  Disseminated herpes infection is the most dangerous type. In this type, the herpes virus can affect many different internal organs including the liver, lungs, kidneys, and brain. There may or may not be vesicles on the skin. This type of infection is often fatal.

  Herpes acquired in the period shortly after birth has symptoms similar to birth-acquired herpes.

  Symptoms of birth-acquired herpes include:

  • Bleeding easily
  • Breathing difficulties
    • Blue appearance (cyanosis)
    • Flaring of the nostrils
    • Grunting
    • Rapid breathing (tachypnea)
    • Short periods without breathing (apneic episodes)
  • Coma
  • Enlarged liver and spleen
  • Jaundice
  • Kidney failure
  • Lethargy
  • Low body temperature (hypothermia)
  • Poor feeding
  • Seizures
  • Shock
  • Skin lesions, fluid-filled blisters
  • Stress or anxiety
• Signs and tests

  Tests for birth-acquired herpes include:

  • DFA test for herpes (scraping from vesicle)
  • EEG
  • MRI of the head
  • Spinal fluid culture
  • Vesicle culture

  Additional tests that may be done if the baby is very sick include:

  • Blood gas analysis
  • Coagulation studies (PT, PTT)
  • Complete blood count
  • Electrolyte measurements
  • Tests of liver function
• Treatment

  Herpes virus infections in infants are generally treated with medicine given through a vein (intravenous). Acyclovir is the most common antiviral medicine used for this purpose. The baby may need to take the medicine for several weeks.

  Other therapy is often needed to treat the effects of herpes infection, such as shock or seizures. Often, because these babies are very ill, treatment is done in an intensive care unit.

• Expectations (prognosis)

  Infants with systemic herpes or encephalitis often do poorly, despite antiviral medications and early treatment.

  In infants with skin disease, the vesicles may come back repeatedly even after treatment is finished. These recurrences put them at risk for learning disabilities, and may need to be treated.

• Complications
  • Bacterial or fungal infection of skin lesions
  • Coma
  • Death
  • Developmental delay
  • Excessive bleeding, disseminated intravascular coagulation (DIC)
  • Eye problems (chorioretinitis, keratitis)
  • Gastrointestinal problems, including diarrhea
  • Hepatitis
  • Jaundice
  • Liver failure
  • Lung problems including pneumonia or pneumonitis
  • Brain and nervous system (neurological) problems
  • Respiratory distress
  • Seizure
  • Shock
  • Skin lesions
• Calling your health care provider

  If your baby has any symptoms of birth-acquired herpes, including skin lesions alone, have the baby seen by your health care provider promptly.

• Prevention

  Safer sexual practices can help prevent the mother from getting genital herpes. Mothers who are not infected with herpes cannot pass the herpes virus to the fetus during delivery.

  People with "cold sores" (herpes labialis) should avoid contact with newborn infants. If the person with a cold sore is a caregiver, have them wear a surgical mask and wash their hands carefully before coming into contact with the infant to prevent transmitting the virus.

  Mothers should speak to their health care providers about the best way to minimize the risk of transmitting herpes to their infant.

• References

  Cernik C, Gallina K, Brodell RT. The treatment of herpes simplex infections: An evidence-based review. Arch Intern Med. 2008;168(11):1137-1144.

  Hollier LM, Wendel GD. Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database Syst Rev. 2008;23(1):CD004946.

Review Date: 10/15/2008

Reviewed By: Daniel Rauch, MD, FAAP. Director, Pediatric Hospitalist Program, New York University School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.