Infant Journal
for neonatal and paediatric healthcare professionals

Neonatal herpes simplex virus infection: maternal risk stratification and management of at-risk neonates

Herpes simplex virus infection during the neonatal period is a relatively rare but serious diagnosis, associated with significant morbidity and mortality. Stratified management of mothers whose infants are at risk of perinatal infection and associated neonatal actions should be considered on a case-by-case basis. In this article, we discuss current guidance and challenges to clinical practice using a case-based approach to aid learning.

Monica Arend-Trujillo
ST4 Paediatric Trainee, Northern Deanery

Lauren Dhugga
ST3 Paediatric Trainee, Northern Deanery

Neonatal Intensive Care Unit, Royal Victoria Infirmary, Newcastle upon Tyne

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herpes simplex virus (HSV); neonate; pregnancy; aciclovir (acyclovir)
Key points
  1. Antenatal detection of HSV must be communicated across obstetric and neonatal teams for optimal care for mother and neonate.
  2. Identifying and managing risk factors antenatally, including empirical maternal antiviral treatment, can reduce vertical transmission of HSV.
  3. Risk stratification should be used to guide investigations and indication for empirical antiviral treatment in neonates.
  4. Women with HSV infection in pregnancy should be counselled about expected management of the neonate and potential prolonged hospital stay.

Also published in Infant:

Unexpected neonatal herpes simplex virus infection in a premature newborn baby
In this article, we describe a case of neonatal herpes simplex virus infection with CNS involvement in an extremely premature infant delivered to a COVID-19 positive mother who had no history or symptoms of genital herpes infection. The infant completed a planned six-month course of acyclovir treatment and then prophylaxis but following discontinuation, he developed skin symptoms. Prophylaxis was resumed and continues at 24 months of age with several subsequent skin outbreaks. The difficulties from the mother’s perspective are also presented.