From the Guidelines
Infants exposed to herpes simplex virus (HSV) require immediate medical attention, and treatment typically involves intravenous acyclovir at 20 mg/kg body weight/dose three times daily for 14-21 days, depending on the extent of infection, as recommended by the CDC and the Infectious Diseases Society of America 1.
Key Considerations
- Neonatal HSV infection can appear as disseminated multiorgan disease, localized disease of the CNS, or disease localized to the skin, eyes, and mouth, with varying presentations and outcomes 2.
- The risk of transmission from an HSV-infected mother to her infant is significant, occurring primarily through exposure to HSV-infected maternal genital fluids during passage through the birth canal, and can result in severe complications if left untreated 3.
- Prevention strategies include careful hand hygiene and avoiding contact between the infant and anyone with active herpes lesions.
Diagnosis and Treatment
- Infants with suspected HSV exposure should be evaluated by a healthcare provider immediately, even if they show no symptoms, and undergo blood tests, spinal fluid analysis, and viral cultures before starting treatment.
- Acyclovir is the drug of choice for treatment of HSV among infants and children, regardless of HIV-infection status, and should be administered for 21 days for CNS and disseminated disease and for 14 days for skin, eye, and mouth disease 1.
- Parents should watch for symptoms including skin vesicles, fever, lethargy, poor feeding, seizures, or respiratory distress, and seek medical attention immediately if they occur.
Outcomes and Prognosis
- Despite treatment, infants with neonatal HSV infection remain at risk for neurologic sequelae, with the most severe neurologic sequelae seen in those with CNS disease 1.
- A limited percentage of infants with localized skin, eye, or mucus membrane disease might have later neurologic sequelae after apparently successful treatment 1.
From the Research
Infant Herpes Simplex Exposure
- Herpes simplex virus (HSV) infections in newborns can have severe consequences, including high morbidity and mortality rates 4.
- The treatment of HSV infections in infants typically involves the use of antiviral drugs, with acyclovir being the primary choice 5, 6, 7.
- Acyclovir can be administered intravenously or orally, with high-dose acyclovir (60 mg/kg/d) being recommended for the treatment of neonatal HSV infections 5.
- However, the safety of high-dose acyclovir in infants has not been extensively studied, and it is not currently approved by the US Food and Drug Administration for use in this population 5.
- Studies have shown that acyclovir is generally well-tolerated in infants, with common adverse events including hypotension, seizure, and thrombocytopenia 5.
- Oral acyclovir may be used as suppressive therapy after acute treatment completion in specific neonatal populations, reducing long-term adverse neurodevelopmental outcomes and future skin eruptions 4.
- Despite advances in treatment, neonatal HSV disease continues to have an unacceptably high mortality rate, and further research is needed to improve prevention and treatment strategies 8.