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Neonatal Herpes Simplex | Overview

"Neonatal herpes simplex is a serious infection that can cause long-term damage to your baby's health if it's not treated. If you've been infected with the virus, tell your doctor as soon as possible."

Sandra Burchett, MD, MSc, Clinical Director, Children?s Hospital Boston Division of Infectious Diseases

You’re likely to be confused and overwhelmed — not to mention scared — if your infant has been diagnosed with neonatal herpes simplex. But you can play an active role in helping him get better. Developing a basic understanding of the condition is a great first step as you partner with your child’s health care team to form a treatment plan.

  • Herpes simplex is a virus that can be passed from mother to baby.
  • 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
  • In nearly 90 percent of the cases of neonatal herpes simplex, the baby contracts the virus in the birth canal, but it is also possible to become infected in utero or just after birth.
  • The virus is inactive at times, but it is incurable and is a lifetime infection.
  • About 1 out of every 3,500 babies born in the United States contracts neonatal herpes simplex.
  • The symptoms nearly always appear during the baby’s first month of life.

Neonatal herpes simplex is a serious infection that, if not treated, can cause long-term damage to your baby’s health. If you know that you’ve been infected with the virus, let your doctor know as soon as possible.

If we find that your baby has been infected with the herpes simplex virus, we will begin treatment to ensure that the condition has a minimal effect on her health.

How Boston Children’s Hospital Boston approaches neonatal herpes simplex

Here at Children’s, physicians in our Fetal-Neonatal Neurology Program treat herpes simplex in infants.

Babies who have a congenital neurological condition need intense, specialized care. We provide comprehensive evaluation and treatment for these young children. Because newborns’ brains are in a crucial window of rapid development, we identify problems as early as possible and intervene quickly.

Newborn medicine

At Children's Division of Newborn Medicine, we specialize in treating babies with a wide range of congenital and acquired conditions. Your baby will be seen by a specially trained team of physicians, nurses, therapists and other health professionals who routinely diagnose and treat newborns with critical illnesses.

Neonatal herpes simplex: Neonatal herpes simplex: Reviewed by Sandra Burchett, MD, MSc, Clinical Director, Children’s Hospital Boston Division of Infectious Diseases

Neonatal Herpes Simplex | Symptoms and Causes

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 Program treat 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.

Neonatal Herpes Simplex | Diagnosis Treatments

How we diagnose neonatal herpes simplex

The first step in treating your child is forming an accurate and complete diagnosis.

Diagnosis is sometimes difficult because babies with neonatal herpes simplex 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 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.

After we complete all necessary tests, our experts meet to review and discuss what they have learned. Then we will meet with you and your family to discuss the results and outline the best treatment options.

How we treat neonatal herpes simplex

If your child has been diagnosed with neonatal herpes simplex, you may be confused, frightened, and overwhelmed. But you can rest assured that, at Boston Children's Hospital, your child is in good hands.

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.

It's important to know the following about herpes simplex in infants:

  • We treat babies born with neonatal herpes 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.

At Boston 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.

Coping and support

It's essential to remember that while hearing that your child is infected with neonatal herpes simplex can feel very isolating, many children and their families have been down this path before. We've helped them, and we can help you, too.

There are lots of resources available for your family — within Boston Children's, in the outside community and online. These include:

  • Patient education: From the very first visit, our nurses will be on hand to walk you through your child's treatment and help answer any questions you may have. And they'll also reach out to you by phone, continuing the care and support you received while at Boston Children's.
  • Parent to parent: Want to talk with someone whose baby has been treated for neonatal herpes simplex? We can put you in touch with other families who have been through similar experiences and can share their experience.
  • Faith-based support: If you are in need of spiritual support, we'll help connect you with the Boston Children's Department of Spiritual Care (chaplaincy). Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian, and United Church of Christ traditions who will listen to you, pray with you, and help you observe your own faith practices during the time you and your child are in the hospital.
  • Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness, and dealing with financial difficulties.

On our patient resources pages, you can read all you need to know about:

Neonatal Herpes Simplex | Research and Clinical Trials

At Boston Children’s Hospital, we’re known for our science-driven approach and our intense culture of innovation — a philosophy that lets us push the boundaries of pediatric care.

Focus on encephalitis

Our patients benefit from our Pediatric Neuro-immunology Program’s expertise: We are a main referral center for pediatric encephalitis in New England. We also have strong ties to the small network of physicians and researchers all over the country who are working to better understand, diagnose and treat this extremely rare condition.

Community-based care for newborns

The Community Newborn Medicine Program cares for ill and convalescent newborns in a family centered, community setting. Our community-based Newborn Medicine faculty provide advanced newborn therapies in Neonatal Intensive Care Units (NICU) and in Special Care Nurseries (SCN) in several suburban medical centers that are affiliated with Children's.

The affiliated nursery programs include:

NICU

SCN

Neonatal Herpes Simplex | Programs & Services