Infant Journal
for neonatal and paediatric healthcare professionals

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.

Mahmoud Koritena
Neonatal Clinical Fellow

Jennifer McGrath
Consultant Neonatologist
St Peter's Hospital, Chertsey, Surrey

Koritena M., McGrath J.
Unexpected neonatal herpes simplex virus infection in a premature newborn baby. Infant 2023; 19(4): 141-44.

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herpes simplex virus (HSV); neonate; pregnancy; acyclovir (aciclovir)
Key points
  1. HSV infection in a newborn baby can be associated with significant morbidity and mortality.
  2. HSV infection should be considered in a sick neonate, even when an alternative diagnosis is made. When appropriate, an investigation for HSV and prompt treatment should be instigated.
  3. Appropriate diagnosis and treatment with antiviral therapy can significantly improve the outcome of these infants.
  4. Infants with neonatal HSV disease should receive at least six months of oral acyclovir suppressive therapy.

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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.