What is the evidence-based practice (EBP) for a neonate born to a mother with active Herpes Simplex Virus (HSV) and marginal prenatal care?

From the Guidelines

For a neonate born to a mother with active herpes simplex virus (HSV) and who is marginally ill, the evidence-based practice recommendation is to immediately start intravenous (IV) acyclovir at 20 mg/kg/dose three times daily for a minimum of 14 days for skin, eye, and mouth disease or 21 days for CNS and disseminated disease. This recommendation is based on the guidelines from the CDC, the National Institutes of Health, and the Infectious Diseases Society of America, as outlined in the study published in MMWR Recommendations and Reports 1. The study emphasizes the importance of early treatment with acyclovir in reducing morbidity and mortality in neonates with HSV infection. Key considerations in managing these cases include:

• Obtaining samples for HSV PCR testing from blood, cerebrospinal fluid, and surface swabs (mouth, nasopharynx, conjunctivae, and rectum) before starting treatment
• Isolating the neonate from other infants to prevent transmission
• Closely monitoring the neonate for clinical deterioration, as even marginally symptomatic infants can rapidly deteriorate
• Not delaying treatment while awaiting test results, as early intervention is critical for improving outcomes, as noted in the study 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Evidence-Based Practice for Neonates Born to Mothers with Active HSV

• The risk of transmitting HSV to a neonate is highest when the mother sheds HSV at labor, which occurs more frequently in women who acquire genital herpes in the third trimester 2.
• Observational studies suggest that caesarean section can reduce transmission of neonatal herpes, and is warranted for women who shed HSV at delivery 2.
• The management of asymptomatic neonates born to women with active genital herpes lesions should be tailored according to the mother's previous immunity to HSV and the type of maternal infection 3.
• Acyclovir prophylaxis in late pregnancy can prevent recurrent genital herpes and viral shedding, and may reduce the risk of mother-to-child transmission at delivery 4.

Prevention Strategies

• High-risk susceptible women should be counselled about abstinence and reducing oral-genital contact near term 2.
• The use of weekly viral cultures in pregnant women with confirmed genital herpes is not warranted, as they do not predict an infant's risk of acquisition of HSV at delivery and are not cost-effective 2.
• Invasive fetal monitoring can increase the risk of neonatal herpes, and should only be used in HSV-2 seropositive women for defined obstetrical indications 2.

Diagnosis and Treatment

• Neonatal presentation of HSV infection can range from limited disease with skin, eye, and mouth disease to central nervous system disease or disseminated disease 5.
• Treatment with acyclovir should be tailored according to symptoms and signs of infection, and virological tests 5.
• Children with neonatal HSV infection need a multidisciplinary follow-up to timely intercept any deviation from normal neurodevelopmental milestones 5.