New York Injury Talk Blog

Neonatal herpes, either type I or II, is a serious viral infection of the infant which needs immediate hospitalization and treatment. Herpes virus type I is marked by the eruption of vesicle lesions on the lips or nostrils, versus herpes virus type II which has lesions located on the genitalia. If localized neonatal herpes is left untreated, the virus may become disseminated into a virulent and fatal form. Thus, time is of the essence in the diagnosis and treatment of the localized herpes, to prevent infecting fulminating spread. Without immediate treatment, the mortality rate is over 80%, and the infants that do survive have significant permanent neurologic damages.

Overall, two (2) out of 1000 mothers have positive herpes simplex cultures at delivery, even though they have no clinical symptoms. According to the literature, there is a shedding of the virus for approximately three (3) weeks during a maternal infection outbreak. Transmission of neonatal herpes requires direct contact between the mother and infant. In the majority of cases, the infection is transmitted during labor and delivery. However, there is also known infant exposure post-delivery, if either parent has a cold sore or herpes outbreak (type I).

Neonatal herpes usually presents during the second week of life, but as late as four weeks. The first signs of the localized infection include clusters of discrete vesicles on the skin, mucosal ulcers or white lesions in the mouth, eye or ocular lesions, and lesions in the genital area. In some cases, infants present with no topical lesions, but with irritability, seizures, fevers, bulging fontanel and poor feeding. Thus, the physician needs to obtain a complete history and physical of the infant to identify possible herpes simplex virus infection. Once there is a differential diagnosis of neonatal herpes, decisive action must be taken promptly to make a correct diagnosis and intervene with treatment. The physician should perform a spinal tap for viral and bacterial cultures, blood for HSV serology, and wound cultures of the topical lesions. At the time of work-up, the infant must be immediately started with antiviral medication (intravenous Acyclovir) to prevent further spreading of the disease. Over a seven day period, intravenous Acyclovir 45mg/kg/day is usually effective in treating an infant’s localized infection. If the spinal tap culture or blood cultures turn positive, Acyclovir treatment is recommended for (21) twenty one days.

The good news is that if diagnosed early and treatment is started immediately a good outcome is likely.

For more information on this or other birth complications, please contact the New York Birth Injury Lawyers at our law firm.