Neonatal HSV

Background

• Causative agent: HSV-1 or HSV-2
• Definition – “infection acquired peri-natally or postnatally without clinical manifestations at birth or in the first 24 hours of life but with subsequent clinical manifestations in the neonatal period (age less than 29 days)” (1)
• ED prevalence:
  • 0.2% all neonates
  • 0.3% febrile neonates
  • 0.5% neonates undergoing LP
• Prevalence similar to meningitis (0.4%) in neonates presenting for SBI (2)
• Risk associated with age <3 weeks, primary maternal HSV infection at delivery

Risk Factors in Neonatal Fever

^Acyclovir if:

• HSV infection in baby or mother
• CSF pleocytoisis
• Concerning skin lesions
• Seizures
• Abnormal LFTs

Management

• Acyclovir 20 mg/kg IV every 8 hours (duration depends on classification)
• If ocular involvement:
  • 1% trifluridine, 0.1% iododeoxyuridine, or 3% vidarabine
  • Optho consult
• As for any febrile neonate SBI evaluation:
  • Ampicillin + gentamycin
    • May substitute gentamycin with cefotaxime/ceftazidime

See Also

• Neonatal conjunctivitis
• Pediatric fever of uncertain source
• Herpes viruses