Neonatal herpes simplex Symptoms & Causes

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In-Depth

At Children’s Hospital Boston, we understand that you may have a lot of questions when your child is diagnosed with neonatal herpes simplex.

•           What exactly is it?

•           What are potential complications in my child’s case?

•           What are the treatments?

•           Are there any possible side effects from treatment?

•           How will it affect my child long term?

We’ve tried to provide some answers to those questions here, and when you meet with our experts, we can explain your child’s condition and treatment options fully.

Background

According to the Centers for Disease Control and Prevention (CDC), about .03% of babies born in the United States contract neonatal herpes simplex, most of them as they pass through the birth canal—in rare circumstances, it is also possible for a baby to be infected in the uterus or immediately after birth.

  • Some studies indicate that delivery by Caesarean section, which avoids the birth canal, can reduce the risk of congenital herpes.  

Causes

The herpes simplex virus can be transmitted from a mother to her baby before, during or after birth.

  • If you have had a history of herpes infections, make sure to let your doctor know before you give birth.

Symptoms

Some signs that your baby may have herpes are:

  • irritability
  • blisters anywhere on her body
  • trouble breathing
    • grunting
    • blue appearance (cyanosis)
    • rapid breathing
    • short periods of no breathing
  • jaundice
  • bleeding easily

Herpes simplex infections can be divided into three categories:

  • localized skin infection— small, fluid-filled blisters on the skin and around the eyes and mouth that burst, crust over, and heal
  • encephalitis an inflammation of the brain, which can cause problems with brain and spinal cord function, including seizures
  • disseminated herpes infection— the most dangerous type of herpes infection. The herpes virus is spread throughout your child’s body and can affect multiple organs, including the liver, brain, lungs, and kidney.

A baby infected with herpes may not have all the symptoms of the disease.

  • Most symptoms surface by the end of the baby's first week, while more severe central nervous system problems will not appear until the baby's second week.

If left untreated, encephalitis and disseminated herpes infections are potentially fatal.

Long-term outlook

Neonatal herpes simplex is a serious condition that can even be fatal if left untreated. If we begin treatment quickly, however, we can minimize the long-term effects on your child’s health.

For more information, see the Treatment and Care tab.

Questions to ask your doctor

Many parents are concerned about neonatal herpes simplex and can have lots of questions about the condition and how it can affect their baby.

You may find it helpful to jot down questions as they arise—that way, when you talk to your doctor, you can be sure that all of your concerns are addressed.

Here are some questions to get you started:

  • Should I get tested for herpes?
  • What can I do to prevent infection?
  • I have herpes. Is there any way to prevent passing it on to my baby?
  • What steps can we take if my baby does get infected?
  • What’s the long-term outlook for a baby with neonatal herpes?

FAQ

Q: What is herpes simplex?
A: Herpes simplex is a virus that can be passed from mother to baby, and potentially cause a serious infection in a newborn.

Q: How common is neonatal herpes simplex?
A: About 1 out of every 3,500 babies born in the United States contracts neonatal herpes simplex.

Q: Why is neonatal herpes simplexa problem?
A: Neonatal herpes simplex is a serious condition that requires immediate treatment. If left untreated, the virus can cause brain and spinal cord function, as well as cause harm to the liver, lungs and kidneys. For more information on potential problems, see Signs & Symptoms [LINK].

Q: Is there any way to prevent infection?
A: Most babies born to mothers infected with the herpes simplex virus are completely healthy. However, a baby is at greater risk for contracting herpes if the mother's first herpes infection occurs in the third trimester of pregnancy.

  • Some studies indicate that delivery by Caesarean section, which avoids the birth canal, can reduce the risk of congenital herpes.  

Q: How can I tell if my baby has neonatal herpes simplex?
A: Signs that your baby may have herpes are:

  • irritability
  • blisters anywhere on her body
  • trouble breathing
    • grunting
    • blue appearance (cyanosis)
    • rapid breathing
    • short periods of no breathing
  • jaundice
  • bleeding easily

However, some of these symptoms are also present with other conditions, so the best way to know for sure is to check with your child’s doctor.

Q: How is neonatal herpes simplex diagnosed?
A: Diagnosis is sometimes difficult because babies with neonatal herpes may not have the characteristic blisters of the disease. In addition, many symptoms of herpes resemble other diseases or disorders. However, the following tests can diagnose neonatal herpes:

  • Skin culture — taking a sample of the blister by scraping or removing a piece of tissue
  • Blood test
  • Swab culture — taking a sample with a cotton swab from the nose, throat or rectum
  • Urine test
  • CT scan or MRI scan of the head

If you or your doctor suspects that your baby may have neonatal herpes simplex, we typically test both the mother and the baby for the presence of the virus.

  • If you are pregnant and know that you have herpes simplex or know that you’ve recently been exposed to the virus, ask your doctor to perform a test.

Q: What are our treatment options?
A: Here at Children’s, physicians in our Fetal-Neonatal Neurology Programtreat neonatal herpes simplex in infants.

  • We treat babies with neonatal herpes simplex with a course of intravenous antiviral medication over a period of several weeks.
    • The most commonly used treatments for neonatal herpes are called ganciclovir and valganciclovir.

Q: What is my child’s long-term outlook?
A:Neonatal herpes simplex is a serious condition that can even be fatal if left untreated. If we begin treatment quickly, however, we can minimize the long-term effects on your child’s health.

For more information, see the Treatment and Care  tab.

Q: What makes Children’s different?
A: Our physicians are expert, compassionate and committed to focusing on the whole child, not just his condition—that’s one reason we’re frequently ranked as a top pediatric hospital in the United States.

And at Children’s, we consider you and your child integral parts of the care team and not simply recipients of care. You and your care team will work together to customize a plan of care for your child.

Fetal-Neonatal Neurology Program
Learn more about our program for babies with congenital neurological conditions.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

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