Exam 4 - HSV in the Newborn Flashcards
True/False: incidence of HSV decreases with prematurity
False - HSV incidence increases with prematurity
What percentage of pregnant women infected with herpes are unaware of their infection?
90%
At what age do symptoms of herpes present in the newborn?
Symptoms appear at any time from birth to 4 weeks
Does disseminated herpes appear earlier or later in the newborn?
Earlier - first few weeks of life
How does a local herpes infection present on the skin, eyes, and mouth of a newborn?
Skin: vesicles or bullae
Eye: conjunctivitis, keratitis, or retinitis
Mouth: ulcers
When do local herpes infections present in the newborn? Where do they present?
First or second week of life
Initial lesions present at areas of trauma (e.g. scalp electrodes)
What are associated CNS herpes symptoms? When do these symptoms usually present?
Symptoms: seizures, encephalitis
Occurs most commonly during second or fourth week
What are usual disseminated herpes infection symptoms?
General symptoms of bacterial sepsis + hepatitis, encephalitis, pneumonitis, and DIC
What organ systems does disseminated herpes infections effect? When do symptoms normally present?
Can affect all major organs
Usually presents during first two weeks
Where should the provider collect cultures from to diagnose HSV in the newborn?
- Vesicles
- Nasopharyngeal or conjunctival swabs
- Urine
- Stool
- Tracheal secretions
- CSF
What diagnostic test could be utilized with vesicle scrapings of a herpes lesion?
Rapid diagnostic tests
When should the provider collect cutaneous and mucosal cultures after delivery?
Obtained 24-48 hours after delivery to differentiate colonization from true infection
- Cultures should be obtained IMMEDIATELY in symptomatic infants
How long does it take to identify the strain of herpes virus after specimen collection?
Viral identification takes 1-3 days
Treatment options for HSV with skin or mucus membrane involvement
Acyclovir IV 20 mg/kg/dose every 8 hours for 14 days
Treatment options for HSV with CNS involvement
Acyclovir IV 20 mg/kg/dose every 8 hours for 21 days
How would the provider prevent primary HSV infections before and after birth?
- Before - consider c-section
- After - empiric acyclovir IV q8h pending neonatal cultures
If there is HSV reactivation, when should cultures be obtained?
24 to 48 hours after birth
Does the provider always need to initiate treatment for HSV in the newborn?
Do not need to initiate therapy unless infant is symptomatic, premature, or has acquired open wounds during delivery
What education should be provided for persons with herpes labiablis (cold sores) in being around newborns?
- Follow strict hand washing
- Avoid contact with infant
- Wear a mask when holding the infant until the lesion is crusted over
Is it okay for women to breastfeed if they have a herpes infection?
Breastfeeding is acceptable as long as lesions are not on the breast
How long should infants be followed after confirmed or suspected herpes infection?
Infants at risk, even if culture negative, need to be followed closely for at least 6 weeks
What precautions should be taken if neonates are born to mothers with active lesions?
Neonates born to mothers with active lesions should be separated from other neonates and put on contact precautions
