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Definition

Newborn infants can become infected with herpes virus during pregnancy, during labor or delivery, or after birth.

Causes

Newborn infants can become infected with herpes virus:

• In the uterus (this is unusual)
• Passing through the birth canal (birth-acquired herpes, the most common method of infection)
• Right after birth (postpartum) from being kissed or having other contact with someone who has herpes mouth sores

If the mother has an active outbreak of genital herpes at the time of delivery, the baby is more likely to become infected during birth. Some mothers may not know they have herpes sores inside the vagina.

Some women have had herpes infections in the past, but are not aware of it, and may pass the virus 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

Herpes may only appear as a skin infection. Small, fluid-filled blisters (vesicles) may appear. These blisters break, crust over, and finally heal. A mild scar may remain.

Herpes infection may also spread throughout the body. This is called disseminated herpes. In this type, the herpes virus can affect many parts of the body.

• Herpes infection in the brain is called herpes encephalitis
• The liver, lungs, and kidneys may also be involved
• There may or may not be blisters on the skin

Newborn infants with herpes that has spread to the brain or other parts of the body are often very sick. Symptoms include:

• Skin sores, fluid-filled blisters
• Bleeding easily
• Breathing difficulties such as rapid breathing and short periods without breathing, which can lead to nostril flaring, grunting, or blue appearance
• Yellow skin and whites of the eyes
• Weakness
• Low body temperature (hypothermia)
• Poor feeding
• Seizures, shock, or coma

Herpes that is caught shortly after birth has symptoms similar to those of birth-acquired herpes.

Herpes the baby gets in the uterus can cause:

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

Exams and Tests

Tests for birth-acquired herpes include:

• Checking for the virus by scraping from vesicle or vesicle culture
• EEG
• MRI of the head
• Spinal fluid 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

It is important to tell your health care provider at your first prenatal visit if you have a history of genital herpes.

• If you have frequent herpes outbreaks, you'll be given a medicine to take during the last month of pregnancy to treat the virus. This helps prevent an outbreak at the time of delivery.
• C-section is recommended for pregnant women who have an active outbreak of herpes sores and are in labor.
• You may have some prodromal symptoms before a sore appears. You may experience itching in the affected area, "tingling" or "pinching" sensations, muscle tenderness, shooting pains in the buttocks, legs, or groin, and nerve pain in the leg. Be sure to notify your provider if you are having these sensations.
• For women with a first-episode genital herpes infection during the third trimester of pregnancy, C-section may be offered due to the possibility of prolonged viral shedding.

Herpes virus infection in infants is generally treated with antiviral medicine given through a vein (intravenous). The baby may need to be on the medicine for several weeks.

Treatment may also be needed for the effects of herpes infection, such as shock or seizures. Because these babies are very ill, treatment is often done in the hospital intensive care unit.

Outlook (Prognosis)

Infants with systemic herpes or encephalitis often do poorly. This is despite antiviral medicines and early treatment.

In infants with skin disease, the vesicles may keep coming back, even after treatment is finished.

Affected children may have developmental delay and learning disabilities.

When to Contact a Medical Professional

If your baby has any symptoms of birth-acquired herpes, including skin blisters with no other symptoms, have the baby seen by the provider right away.

Prevention

Practicing safe sex can help prevent the mother from getting genital herpes.

People with cold sores (oral herpes) should not come in contact with newborn infants. To prevent transmitting the virus, caregivers who have a cold sore should wear a mask and wash their hands carefully before coming in contact with an infant.

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

References

Dinulos JGH. Sexually transmitted viral infections. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 11.

Duff P. Maternal and fetal infections. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 51.

Kimberlin DW, Baley J; Committee on infectious diseases; Committee on fetus and newborn. Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Pediatrics. 2013;131(2):e635-e646. PMID: 23359576 pubmed.ncbi.nlm.nih.gov/23359576/.

Kimberlin DW, Gutierrez KM. Herpes simplex virus infections. In: Wilson CB, Nizet V, Maldonado YA, Remington JS, Klein JO, eds. Remington and Klein's Infectious Diseases of the Fetus and Newborn Infant. 8th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 27.

Schiffer JT, Corey L. Herpes simplex virus. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 135.

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