Congenital Herpes

Causes, incidence, and risk factors:

Newborn infants can become infected with herpes virus while in the uterus, during passage through the birth canal (birth-acquired herpes, the most common method of infection), or in the period immediately following birth (postpartum).
If the mother has an active genital herpes infection at the time of delivery, the infant is more likely to become infected during the birthing process. It is possible for a mother with a primary (first-time) herpes infection to transmit the virus to a child during birth.
In addition, some people have had herpes infections in the past, but have not been diagnosed or treated. These people, not knowing that they have it themselves, may pass herpes on to their child. Herpes type 2 (genital herpes) is the most common cause of herpes infection in newborn babies, but herpes type 1 can also occur.
Intrauterine herpes is very rare. It can cause severe brain damage, eye disease, such as inflammation of the retina, and skin lesions.
Birth-acquired herpes can produce localized or systemic (throughout the body) disease. Infants may develop only a localized skin infection consisting of small fluid-filled blisters that rupture, crust over, and finally heal, often leaving a mild scar.
A second type of birth-acquired herpes infection leads to encephalitis, an inflammation of the brain that can result in seizures and later neurologic (brain and nervous system) problems. If untreated, it may lead to death.
The third type of infection, disseminated herpes infection, is the most dangerous. In this type, the herpes virus can affect many different internal organs including the liver, lungs, kidneys, and brain. There may or may not be vesicles on the skin. This type of infection is often fatal.
Herpes acquired in the period shortly after birth has symptoms similar to birth-acquired herpes.

Symptoms:

The baby may exhibit:
  • Poor feeding
  • Stress or anxiety
  • Skin lesions, fluid filled blisters
  • Breathing difficulties
    • Grunting
    • Flaring of the nostrils
    • Rapid breathing
    • Short periods without breathing (apneic episodes)
    • Blue appearance
  • Shock
  • Lethargy
  • Seizures
  • Enlarged liver and spleen
  • Kidney failure
  • Jaundice
  • Bleeding easily
  • Coma

Signs and tests:

A very ill baby may develop signs of shock, bleeding, seizures, or other signs listed above.
Tests:
  • Vesicle culture
  • Spinal Fluid Culture
  • Urine Culture
  • Swab culture (from nose, throat, or rectum)
  • DFA test for herpes (scraping from vesicle)
  • CT scan of the head
  • MRI of the head
  • Blood gas analysis
  • Tests of liver function
  • Electrolyte measurements
  • Complete blood counts
  • Coagulation studies

Treatment:

Herpes virus infections in infants are generally treated with intravenous medications. Acyclovir is the most common antiviral medicine used for this purpose. A course of several weeks may be required. In addition, other therapy is often necessary to treat the effects of herpes infection such as shock or seizures.

Expectations (prognosis):

Infants with systemic herpes or encephalitis frequently have poor outcomes despite antiviral medications and early intervention. Infants with skin disease may have recurrences after therapy is finished. The recurrences put them at risk for learning disability and may require treatment.

Complications:

  • Skin lesions
  • Bacterial or fungal infection of skin lesions
  • Lung problems including pneumonia or pneumonitis
  • Respiratory distress
  • Hepatitis
  • Jaundice
  • Liver failure
  • Excessive bleeding, disseminated intravascular coagulation (DIC)
  • Eye problems (chorioretinitis, keratitis)
  • Gastrointestinal problems, including diarrhea
  • Shock
  • Seizure
  • Neurologic problems
  • Developmental delay
  • Coma
  • Death

Prevention:

Safer sexual practices can help prevent the mother from acquiring genital herpes.
Individuals with "cold sores" (herpes labialis) should avoid contact with newborn infants. If the individual with a cold sore is a caregiver, use of a surgical mask and scrupulous handwashing prior to contact with the infant will prevent postpartum transmission of the virus.
Mothers who are not infected with herpes cannot pass herpes virus to the fetus during delivery. Mothers should speak to their health care providers about the best way to minimize the risk of transmitting herpes to their infant.
 
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