Medicines for Neonatal herpes

What it is

Neonatal herpes is an infection with the herpes simplex virus (the virus that causes cold sores and genital herpes) in a newborn baby. It is rare, but it is serious and potentially life-threatening, because newborn babies’ immune systems are immature and the infection can spread and cause severe illness — so it is a medical emergency needing urgent treatment. A baby can catch the herpes virus around the time of birth — most commonly from the mother if she has a genital herpes infection at the time of delivery (particularly a first-time infection in late pregnancy, which carries a higher risk), as the baby can be exposed to the virus during birth — or after birth, from close contact with someone who has an active herpes infection, such as a cold sore (for example through a kiss) or a herpetic whitlow. Neonatal herpes can affect the baby in different ways and to different extents: it may be limited to the skin, eyes, and mouth; or it may be more serious, affecting the brain (causing encephalitis) or spreading widely through the body and affecting multiple organs (disseminated infection), which are the more dangerous forms. The signs of neonatal herpes can include: a rash or blisters on the skin, or sores in the mouth or around the eyes; the baby becoming unwell, being irritable or unusually sleepy or floppy, feeding poorly, or having a high or low temperature; breathing problems; and, if the brain is affected, seizures or other signs; the baby may become seriously unwell. Because neonatal herpes is serious and can progress rapidly, any newborn baby who is unwell, or who has blisters, sores, or the signs above — particularly with a relevant exposure — needs urgent medical assessment. Treatment is urgent, in hospital, with antiviral medicine (given into a vein) and supportive care; prompt treatment greatly improves the outcome. There are also measures to reduce the risk of neonatal herpes — including care around genital herpes in pregnancy (with obstetric advice), and simple precautions to protect newborns from people with active cold sores or herpes lesions. The key messages are that neonatal herpes is a rare but serious herpes infection in a newborn needing urgent treatment, that prompt recognition and antiviral treatment are vital, and that some measures reduce the risk.

How it is treated

Neonatal herpes is a medical emergency treated urgently in hospital with antiviral medicine and supportive care, so prompt recognition and treatment are vital; measures to reduce the risk are also important. Because neonatal herpes is serious and can progress rapidly, the priority is urgent recognition and treatment: any newborn baby who is unwell, or who has blisters or sores on the skin, in the mouth, or around the eyes, or the signs of becoming unwell (irritability, unusual sleepiness or floppiness, poor feeding, a high or low temperature, breathing problems, or seizures) — particularly with a relevant exposure (such as maternal genital herpes, or contact with someone with a cold sore or herpes lesion) — needs urgent medical assessment. It is important to mention any relevant herpes exposure to the medical team, as it helps with diagnosis. In hospital, neonatal herpes is diagnosed with tests (such as swabs and other samples to detect the virus, and tests to assess the extent, including whether the brain is affected), and treatment is started urgently — often before results are back if the infection is suspected, because prompt treatment is important. Treatment is with antiviral medicine (aciclovir) given into a vein, usually for a period, to treat the infection, along with supportive care for the baby (which may include intensive care for severe or disseminated infection or when the brain is affected). Prompt antiviral treatment greatly improves the outcome, and the outlook depends on the type and extent of the infection and how quickly treatment is started — the forms limited to the skin, eyes, and mouth have a better outlook, while the forms affecting the brain or spreading widely are more serious, which is why prompt treatment matters. Reducing the risk of neonatal herpes is an important part of care: around pregnancy and birth, genital herpes in the mother is managed with obstetric advice — for example, a first-time (primary) genital herpes infection in late pregnancy carries a higher risk and may lead to advice such as antiviral treatment and, in some situations, considering the mode of delivery (such as a caesarean) to reduce the risk, guided by specialists; and for the mother’s known recurrent genital herpes, management and advice are provided. After birth, simple precautions help protect newborns: people with an active cold sore should avoid kissing a baby and should wash their hands and take care, and people with a herpetic whitlow or other active herpes lesion should avoid contact with the baby’s skin, to reduce the risk of passing the virus to the vulnerable newborn. The reassuring messages, within the seriousness, are that neonatal herpes, although rare and serious, is treatable with urgent antiviral treatment and supportive care, that prompt recognition and treatment greatly improve the outcome, and that measures around genital herpes in pregnancy and simple precautions to protect newborns reduce the risk; so urgent assessment of an unwell newborn or one with blisters or sores (mentioning any relevant exposure), and preventive measures, are the keys.