Herpes in babies

Herpes in babies, also known as neonatal herpes, is a serious viral infection caused by the herpes simplex virus (HSV). It can be transmitted to a baby during pregnancy, childbirth, or shortly after birth. Neonatal herpes is particularly concerning because newborns have immature immune systems, making them more susceptible to severe complications.

Types

Neonatal herpes can be classified into three main types based on the areas of the body affected:

1. Skin, Eye, and Mouth (SEM) Herpes:

   • The most common and least severe form.
   • Symptoms include blisters or sores on the skin, eyes, or mouth.
   • With prompt treatment, this form has a better prognosis.

2. Central Nervous System (CNS) Herpes:

   • Affects the brain and spinal cord.
   • Symptoms include seizures, lethargy, irritability, poor feeding, and a bulging fontanelle (the soft spot on a baby’s head).
   • This form can lead to long-term neurological damage if not treated promptly.

3. Disseminated Herpes:

   • The most severe form, where the infection spreads throughout the body, affecting multiple organs such as the liver, lungs, and brain.
   • Symptoms include fever, poor feeding, jaundice, trouble breathing, and shock.
   • This form has the highest mortality rate and requires immediate medical intervention.

Symptoms

Symptoms of neonatal herpes can vary depending on the type of infection but may include:

• Blisters or Sores: On the skin, eyes, or mouth.
• Fever: Often accompanied by irritability and poor feeding.
• Lethargy: Excessive sleepiness or difficulty waking.
• Seizures: Convulsions or unusual movements.
• Trouble Breathing: Rapid or labored breathing.
• Jaundice: Yellowing of the skin and eyes.
• Shock: Low blood pressure and poor blood circulation.

Causes

Neonatal herpes is caused by the herpes simplex virus, which has two types:

• HSV-1: Typically causes oral herpes but can also cause genital infections.
• HSV-2: More commonly associated with genital herpes and the primary cause of neonatal herpes.

Transmission can occur in several ways:

• During Birth: The most common route, especially if the mother has an active genital herpes infection during delivery.
• In Utero: Rarely, the virus can cross the placenta during pregnancy.
• Postnatally: Through close contact with an infected individual who has active lesions or through contaminated objects.

Diagnosis

Diagnosing neonatal herpes involves several steps:

1. Physical Examination: Checking for characteristic blisters or sores.
2. Medical History: Assessing the mother’s history of herpes infections.
3. Laboratory Tests:
   • Viral Culture: Swabbing lesions to identify the virus.
   • Polymerase Chain Reaction (PCR): Detecting viral DNA in blood, cerebrospinal fluid, or lesion samples.
   • Blood Tests: Checking for antibodies against the herpes virus.

Treatment

Prompt treatment is crucial for managing neonatal herpes. The primary treatment involves antiviral medications:

1. Antiviral Drugs:

   • Acyclovir: Administered intravenously to combat the herpes virus. Dosage and duration depend on the severity and type of infection.
   • Valacyclovir and Famciclovir: May be used in some cases, though less common in neonatal treatment.

2. Supportive Care:

   • Hydration: Ensuring adequate fluid intake, often through intravenous fluids.
   • Nutritional Support: May require feeding through a tube if the baby cannot feed orally.
   • Monitoring and Management of Symptoms: Including controlling seizures and maintaining stable vital signs.

Complications

Neonatal herpes can lead to serious complications if not treated promptly:

• Neurological Damage: Long-term developmental delays, seizures, or cerebral palsy.
• Organ Damage: Particularly with disseminated herpes, affecting the liver, lungs, and other vital organs.
• Death: High mortality rate, especially with disseminated or untreated CNS herpes.

Prevention

Preventing neonatal herpes involves several strategies:

• Prenatal Care: Regular screening and managing herpes infections during pregnancy.
• Cesarean Delivery: Recommended for mothers with active genital herpes lesions at the time of labor to reduce the risk of transmission.
• Antiviral Therapy: Pregnant women with a history of genital herpes may be prescribed antiviral medications in the last weeks of pregnancy to reduce the likelihood of an outbreak during delivery.
• Avoiding Postnatal Exposure: Limiting contact with individuals who have active herpes lesions and practicing good hygiene.

When to See a Doctor

Immediate medical attention is crucial if a baby shows symptoms of neonatal herpes, such as:

• Blisters or sores on the skin, eyes, or mouth.
• Fever, lethargy, or irritability.
• Seizures or unusual movements.
• Difficulty breathing or signs of shock.

Conclusion

Neonatal herpes is a serious condition that requires prompt diagnosis and treatment to prevent severe complications and improve outcomes. Awareness and preventive measures are key to reducing the risk of transmission and ensuring the health and safety of newborns. Regular prenatal care, appropriate delivery planning, and immediate medical attention for symptomatic infants are essential components of managing this potentially life-threatening infection.