Herpetic sepsis of the newborn

Last Updated: 2020-07-17

Author(s): Anzengruber F., Navarini A.

ICD11: -

Often life-threatening herpes initial infection (in 75% HSV type II, increasingly also HSV I) in newborns and premature infants. In 70% of cases, genital HSV type II recurrence in the mother is asymptomatic.

  • Incidence: 1:3,000-10,000 births
  • Latent period: 2-6 days
  • Mostly infection in the birth canal.
  • 10-15% infection by non-genital herpes lesions
  • A diaplacental infection before the 20th SSW usually leads to miscarriage

  • Often difficult course, as HSV meets an immunologically immature organism (only a small amount of antiretroviral cytokines)

Symptoms in the early phase are often non-specific and without vesicular efflorescences. 1/3 of newborns have generalized exanthema with herpes simplex blisters on the skin, 1/3 show herpes blisters only after a delay and 1/3 of newborns do not show any skin symptoms. Aphthous mucosal changes in the sense of gingivostomatitis herpetica, reduced AZ, dyspnoea, loss of appetite, fever or hypothermia, hepatosplenomegaly, dyspepsia, icterus, tendency to bleed, keratoconjunctivitis herpetica, retroflexion of the head as a typical sign of encephalitis (meningism, meningoencephalitis).

  • High mortality (approx. 50-60% in the first week), 20-25% with permanent cerebral disorders

  • Neither in the delivery room nor on a premature infants ward may people with a herpes infection stay

  • Transmission rate: 40-60% infection in mother with active herpes infection

  • In active herpes simplex infection of the mother Sectio caesarea indicated / aspire

 

Systemic Therapy

  • Used in our house:
  • Prophylactic use by the mother before birth & after consultation with the gynaecologists.

 

  • Acyclovir
    • Application: 3x 15!mg/kg bw/d intravenously
    • CI: Hypersensitivity, lactation
    • Side effets (very common): Headache
    • CAVE:
      • In older patients there is an increased risk of reversible neurological disorders
      • Adjustment of dosage for reduced renal function
      • Sufficient liquid supply

 

Topical Therapy

  • Lidocaine (lozenges)
    • Application: max. 12 pieces/d
    • CI: <12 yrs

 

  • Lidocaine (Mouth gel)
    • Application: For painful areas: > 12 years: up to 4 times a day
    • CI: Pregnancy and lactation

 

  • Chlorhexidine (Mouthwash 0.2%)
    • Applciation: Apply after brushing teeth
    • 6-12 years: after consultation with a dentist

 

 

 

 

  • Camomile extract
    • Application: 3 times daily or more often
    • 6 years: In 1 glass of warm water ½ Coffee spoon
    • 1-6 years: 1.5 ml in 1 l water 1x daily
    • CI: Hypersensitivity to ingredients

 

  • Dexpanthenol
    • To use: garnish undiluted or diluted with boiled water several times a day
    • CI: Hypersensitivity to ingredients

 

  • Bedrest
  • Shaking mixture containing zinc

  • Lavasept - Asg.
  • Lotio alba
  • If necessary paracetamol
  • Sufficient intake of fluids and calories

  1. Simonsen, K.A., et al., Early-onset neonatal sepsis. Clin Microbiol Rev, 2014. 27(1): p. 21-47.
  2. Amel Jamehdar, S., et al., Herpes simplex virus infection in neonates and young infants with sepsis. Iran Red Crescent Med J, 2014. 16(2): p. e14310.
  3. Fitzgerald, L.A., et al., Neonatal sepsis: A, B, C--don't ever forget herpes. BMJ Case Rep, 2011. 2011.
  4. Luo, L., et al., [Human parechovirus associated sepsis and central nervous system infections in hospitalized children]. Zhonghua Er Ke Za Zhi, 2014. 52(6): p. 444-8.
  5. Allen, U.D., et al., Prevention and management of neonatal herpes simplex virus infections. Paediatr Child Health, 2014. 19(4): p. 201-12.
  6. Huang, F.K., et al., Bird's Eye View of a Neonatologist: Clinical Approach to Emergency Neonatal Infection. Pediatr Neonatol, 2015.
  7. Nagamori, T., et al., Sequential changes in pathophysiology of systemic inflammatory response in a disseminated neonatal herpes simplex virus (HSV) infection. J Clin Virol, 2012. 53(3): p. 265-7.
  8. Capretti, M.G., et al., Herpes Simplex Virus 1 infection: misleading findings in an infant with disseminated disease. New Microbiol, 2013. 36(3): p. 307-13.
  9. Gunson, R.N., A. Jackson, and C. Aitken, A case of neonatal sepsis with acute liver failure. J Clin Virol, 2011. 50(4): p. 266-9.
  10. Robinson, J.L., et al., Prevention, recognition and management of neonatal HSV infections. Expert Rev Anti Infect Ther, 2012. 10(6): p. 675-85.
  11. Tann, C.J., et al., Prevalence of bloodstream pathogens is higher in neonatal encephalopathy cases vs. controls using a novel panel of real-time PCR assays. PLoS One, 2014. 9(5): p. e97259.
  12. Arnaez Solis, J., et al., [Neonatal sepsis due to herpes simplex virus with fulminant liver failure]. An Pediatr (Barc), 2007. 66(3): p. 313-4.
  13. Fidler, K.J., et al., Could neonatal disseminated herpes simplex virus infections be treated earlier? J Infect, 2004. 49(2): p. 141-6.
  14. Kohl, S., Neonatal herpes simplex virus infections. J Pediatr, 1982. 101(5): p. 794-5.
  15. Filippine, M.M. and B.Z. Katz, Neonatal herpes simplex virus infection presenting with fever alone. J Hum Virol, 2001. 4(4): p. 223-5.
  16. Caviness, A.C., et al., The prevalence of neonatal herpes simplex virus infection compared with serious bacterial illness in hospitalized neonates. J Pediatr, 2008. 153(2): p. 164-9.
  17. Diamond, C., et al., Viremia in neonatal herpes simplex virus infections. Pediatr Infect Dis J, 1999. 18(6): p. 487-9.
  18. Lewensohn-Fuchs, I., et al., Detection of herpes simplex virus DNA in dried blood spots making a retrospective diagnosis possible. J Clin Virol, 2003. 26(1): p. 39-48.
  19. Arvin, A.M., et al., Neonatal herpes simplex infection in the absence of mucocutaneous lesions. J Pediatr, 1982. 100(5): p. 715-21.