Synopsis

 

• Intrauterine HSV infection usually presents within 2 days of birth. It may be associated with prematurity and brain abnormalities (eg, microcephaly, chorioretinitis, cerebral abnormalities) and may resemble epidermolysis bullosa. It typically presents 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.
• 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.

• Neonates delivered by mothers who have had their first (primary) episode of HSV during gestation are at greatest risk for neonatal HSV.
• If active HSV infection is present at the time of delivery, or when there is risk for shedding, cesarean section should be performed, as there is an increased risk of transmission with vaginal delivery.
• Rupture of membranes for more than 4-6 hours before delivery increases the risk of transmission of HSV to the infant, even if delivered via cesarean section.
• The use of fetal scalp electrode monitoring during labor also increases the risk of transmission to the neonate, as it compromises the integrity of the mucocutaneous barriers.