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Potentially life-threatening emergency
Neonatal herpes simplex virus
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Potentially life-threatening emergency

Neonatal herpes simplex virus

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Contributors: Susan Burgin MD, Belinda Tan MD, PhD, Craig N. Burkhart MD, Dean Morrell MD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed

Synopsis

Neonatal herpes simplex virus (HSV) usually results from exposure to maternal HSV at birth (neonatal) or just before birth (intrauterine). Neonates delivered from mothers who have had their first episode of HSV during gestation (primary HSV) are at greatest risk for neonatal HSV. Neonatal HSV can also be acquired after birth (10% of cases). While usually transmitted from adult caregivers, neonatal HSV acquired after birth may also be transmitted to male newborns during out-of-hospital circumcision.

Newborns with intrauterine HSV have skin lesions at birth or within the first 48 hours in the large majority of cases. These neonates are frequently premature and can have associated microcephaly, chorioretinitis, and cerebral abnormalities. Neonatal HSV can either be mucocutaneous, disseminated, or involve the central nervous system (CNS). Disseminated disease can involve the liver, lungs, or present as disseminated intravascular coagulation (DIC).

Maternal history of HSV infection could help aid the diagnosis, but most women are asymptomatic and it is, therefore, not a reliable clue. Prompt diagnosis and treatment is important for rapid treatment. Intrauterine infection presents typically with scarring skin lesions, ophthalmologic findings, and neurologic involvement. A majority of newborns acquire the infection during the peripartum period. Newborns will present with vesicles at birth or within the first few days of life. Lethargy and fever are common findings. Disseminated HSV infection in the neonate can cause encephalitis and is potentially a life-threatening condition. In disseminated disease, CNS infection, DIC, shock, and multiorgan failure are possible. Neonates with CNS involvement may have seizures. Rapid antiviral therapy is imperative in neonates with suspected HSV infection.

For a discussion of HSV acquired by older infants, see herpes simplex virus.

Codes

ICD10CM:
P35.2 – Congenital herpesviral [herpes simplex] infection

SNOMEDCT:
91576008 – Neonatal herpes simplex

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Differential Diagnosis & Pitfalls

Intrauterine HSV infection usually presents within 2 days of birth. It may be associated with prematurity and brain abnormalities and may resemble epidermolysis bullosa.

Neonatal infection may be disseminated, mucocutaneous, or may predominately involve the CNS.

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Last Reviewed: 12/16/2016
Last Updated: 12/16/2016
Copyright © 2019 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Neonatal herpes simplex virus
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Neonatal herpes simplex virus : Seizures, Grouped configuration, Vertex scalp, Poor feeding, Umbilicated vesicles, Skin erosions
Clinical image of Neonatal herpes simplex virus
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