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TAS Neonatal Medicine ✅ > Herpes Simplex Virus Infection ✅ > Flashcards

Herpes Simplex Virus Infection ✅ Flashcards

1
Q

How common is HSV infection in neonates?

A

2-30/100,000 live births

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2
Q

Why is HSV infection in neonates in important?

A

It is one of the most serious infections in newborns

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3
Q

What is the risk of HSV infection if the mother has primary infection at delivery?

A

25-60%

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4
Q

Why is the risk of infection high if the mother has primary infection during delivery?

A

As the infant is exposed during passage through the infected birth canal, and the infant will not have passively acquired maternal antibody

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5
Q

What is the risk of HSV infection in the neonate in mothers with recurrent HSV infection, or where primary infection has happened well below delivery?

A

2%

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6
Q

Is there a risk of infection to the neonate when a parent or caregiver has cold sores?

A

Small risk

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7
Q

What reduces the risk of HSV transmission to the neonate when the parent/caregiver has cold sores?

A

Careful hand hygiene

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8
Q

What is the problem with prevention of HSV infection in neonates?

A

In the majority of cases, the mother is a symptomatic or becomes unwell, but the condition is not diagnosed

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9
Q

How can risk of HSV transmission to the neonate be reduced if the maternal infection is known about?

A
  • C-section delivery
  • Maternal aciclovir
  • Avoidance of invasive obstetric procedures
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10
Q

What invasive obstetric procedures should be avoided when the mother is known to be infected with HSV?

A
  • Mechnically-assisted deliveries

- Fetal scalp electrodes

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11
Q

What can act as a portal of entry for HSV in neonates?

A
  • Skin
  • Eyes
  • Mouth
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12
Q

What can happen once HSV has entered the body in a neonate?

A

Can disseminate to the brain and other organs

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13
Q

What are the modes of presentation of HSV infection in the neonate?

A
  • Localised
  • Encephalitis
  • Systemic
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14
Q

How does localised neonatal HSV present?

A

Skin manifestations with rash, conjunctivitis, or mouth

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15
Q

When does localised neonatal HSV usually present?

A

Second week of life

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16
Q

How does localised neonatal HSV present?

A

With vesicles

17
Q

What is the prognosis of localised neonatal HSV?

A

The prognosis is generally good, but neurodevelopmental complications may arise

18
Q

What is the mortality of HSV encephalitis?

A

10-15%

19
Q

When does systemic neonatal HSV present?

A

10-12 days

20
Q

How does systemic neonatal HSV present?

A
  • Respiratory failure
  • Circulatory collapse
  • Shock
  • Deranged clotting
21
Q

What might systemic neonatal HSV be accompanied by?

A

Encephalitis

22
Q

What is the prognosis of neonatal systemic HSV?

A

50% mortality, with high rate of neurodisability amongst survivors

23
Q

What is the most important thing in the management of neonatal HSV?

A

Early suspicion and antiviral treatment with IV aciclovir and supportive care

24
Q

In what % of neonates with systemic HSV or encephalitis are vesicles present?

A

2/3

25
Q

What is the problem with vesicles not always being present with systemic HSV or encephalitis?

A

Often delays diagnosis

26
Q

How is a diagnosis of neonatal HSV made?

A

PCR of blood, CSF, or local lesions

27
Q

Who is at the greatest risk of neonatal HSV?

A

Infants born by vaginal delivery in mothers with primary HSV infection at the time of delivery

28
Q

What is required for infants at the highest risk of neonatal HSV?

A

IV aciclovir

29
Q

How long do infants at high risk of neonatal HSV need IV antibiotics for?

A

Until active infection is ruled out

30
Q

What treatment is required for infants who were born by C-section to mothers with active HSV?

A

Observation, but no active treatment

31
Q

What treatment is required for infants born to mothers with recurrent HSV, with or without active lesions?

A

No active treatment unless infant becomes symptomatic

TAS Neonatal Medicine ✅ (35 decks)

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