Neonatal herpes simplex is an infection a baby usually picks up during birth from a mother who sheds the virus, often with no known history of genital herpes. It shows up in the first weeks of life and can damage the brain or spread to many organs, so early IV acyclovir saves lives.
Key symptoms
- Small fluid-filled blisters on the skin, eyes or mouth
- Poor feeding, sleepiness or irritability
- Fever or low temperature
- Seizures
- Symptoms often start between days 5 and 21 of life
What you find on exam
- Clustered blisters on a red base; check the scalp where monitors were placed
- Eye exam for keratitis or conjunctivitis
- Lethargy, bulging fontanelle or abnormal tone
- Breathing trouble, jaundice or enlarged liver in spread disease
Tests
- HSV PCR from swabs of the skin, mouth, eyes and rectum
- Blood HSV PCR
- Lumbar puncture with CSF HSV PCR
- Liver enzymes; EEG and brain MRI if neurologic signs
Treatment basics
- Start high-dose IV acyclovir as soon as HSV is suspected
- Treat 14 days for skin, eye and mouth disease, 21 days for brain or spread disease
- Repeat CSF PCR before stopping treatment in brain disease
- Oral acyclovir suppression for 6 months after IV therapy
- Supportive care for seizures, breathing and blood pressure
Red flags
- Seizures or decreased responsiveness
- Breathing trouble or low blood pressure
- Fever or low temperature in a baby under 4 weeks
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.