Exam 4 - HSV in the Newborn

Question 1

True/False: incidence of HSV decreases with prematurity

Answer 1

False - HSV incidence increases with prematurity

Question 2

What percentage of pregnant women infected with herpes are unaware of their infection?

Answer 2

90%

Question 3

At what age do symptoms of herpes present in the newborn?

Answer 3

Symptoms appear at any time from birth to 4 weeks

Question 4

Does disseminated herpes appear earlier or later in the newborn?

Answer 4

Earlier - first few weeks of life

Question 5

How does a local herpes infection present on the skin, eyes, and mouth of a newborn?

Answer 5

Skin: vesicles or bullae

Eye: conjunctivitis, keratitis, or retinitis

Mouth: ulcers

Question 6

When do local herpes infections present in the newborn? Where do they present?

Answer 6

First or second week of life

Initial lesions present at areas of trauma (e.g. scalp electrodes)

Question 7

What are associated CNS herpes symptoms? When do these symptoms usually present?

Answer 7

Symptoms: seizures, encephalitis

Occurs most commonly during second or fourth week

Question 8

What are usual disseminated herpes infection symptoms?

Answer 8

General symptoms of bacterial sepsis + hepatitis, encephalitis, pneumonitis, and DIC

Question 9

What organ systems does disseminated herpes infections effect? When do symptoms normally present?

Answer 9

Can affect all major organs

Usually presents during first two weeks

Question 10

Where should the provider collect cultures from to diagnose HSV in the newborn?

Answer 10

• Vesicles
• Nasopharyngeal or conjunctival swabs
• Urine
• Stool
• Tracheal secretions
• CSF

Question 11

What diagnostic test could be utilized with vesicle scrapings of a herpes lesion?

Answer 11

Rapid diagnostic tests

Question 12

When should the provider collect cutaneous and mucosal cultures after delivery?

Answer 12

Obtained 24-48 hours after delivery to differentiate colonization from true infection

• Cultures should be obtained IMMEDIATELY in symptomatic infants

Question 13

How long does it take to identify the strain of herpes virus after specimen collection?

Answer 13

Viral identification takes 1-3 days

Question 14

Treatment options for HSV with skin or mucus membrane involvement

Answer 14

Acyclovir IV 20 mg/kg/dose every 8 hours for 14 days

Question 15

Treatment options for HSV with CNS involvement

Answer 15

Acyclovir IV 20 mg/kg/dose every 8 hours for 21 days

Question 16

How would the provider prevent primary HSV infections before and after birth?

Answer 16

• Before - consider c-section
• After - empiric acyclovir IV q8h pending neonatal cultures

Question 17

If there is HSV reactivation, when should cultures be obtained?

Answer 17

24 to 48 hours after birth

Question 18

Does the provider always need to initiate treatment for HSV in the newborn?

Answer 18

Do not need to initiate therapy unless infant is symptomatic, premature, or has acquired open wounds during delivery

Question 19

What education should be provided for persons with herpes labiablis (cold sores) in being around newborns?

Answer 19

• Follow strict hand washing
• Avoid contact with infant
• Wear a mask when holding the infant until the lesion is crusted over

Question 20

Is it okay for women to breastfeed if they have a herpes infection?

Answer 20

Breastfeeding is acceptable as long as lesions are not on the breast

Question 21

How long should infants be followed after confirmed or suspected herpes infection?

Answer 21

Infants at risk, even if culture negative, need to be followed closely for at least 6 weeks

Question 22

What precautions should be taken if neonates are born to mothers with active lesions?

Answer 22

Neonates born to mothers with active lesions should be separated from other neonates and put on contact precautions