divided q8h for 14 days
May be lengthened to 21 days in the near future
Dissiminated and CNS HSV infections
60mg/kg/day divided q8h for 21 days
INFECTION CONTROL STEPS
Polymerase chain reaction on CSF and blood
Fluorescent antibody stain on vesicle scraping
EEG Brain Imaging
Chest Radiograph
May demonstrate bilateral, diffuse pneumonia
THE FIRST AFFLIATED HOSPITAL OF GUANGXI MEDICAL UNIVERSITY
DEPARTMENT OF PEDIATRICS NICU
VIROLOGY
● HSV is a DNA virus ● HSV-I, HSV-II
HSV-II associated with poorer outcome
Intrauterine
- Maternal viremia - Ascending infection - Usually after prolonged rupture
of membranes
2. Perinatal
-HSV infection is present in the genital tract of pregnant woman at time of delivery
Mother with lesions on hands hand hygiene and gloves
references
1.Excessive watering of the eye 2.Crying from apparent eye pain 3.Conjunctival erythema 4.Periorbital skin vesicles 5.Can progress to cataracts and
chorioretinitis permanent vision loss
eyes, and mouth,DIC
Diagnosis of Neonatal HSV Infection
Gold standard = Positive culture
of: lesion, nasopharynx, conjunctiva, rectum, or CSF
Rapid diagnostic methods
Abdominal US
May demonstrate ascites and/or enlarged liver in neonates with HSV hepatitis and acute liver failure
TREATMENT
Acyclovir is the treatment of choice Dose-skin eye mouth infection 60mg/kg/day
CLINICAL MANIFESTATIONS
-Skin, Eye, Mouth -Central Nervous System -Disseminated Disease
> 90% present between 5-19 days of age
> 20% NEVER have skin lesions Initial symptoms vague in 30%
Mouth
-Localized ulcerative lesions of the mouth, palate, and tongue
CNS Disease
1/3 of neonatal HSV disease involves the CNS
Presents in second-third week of life
-Most common mode (85%) of neonatal HSV infection
3. Postnatal
-When active HSV infection has close contact with the newborn
intrauterine 5% perinatal 85% postnatal 10%
Pregnant women primary or first episode: Acyclovir therapy at 36 wk 400mg tid
Primary HSV in 3rd trimester: C-section should be offered
Hand washing before and after care of infants
Irritability Tremors Poor feeding
HERPEd Disease
¼ of HSV disease is in the disseminated form
Present in the first week of life Affects: liver, lungs, adrenals, CNS, skin,
TRANSMISSION
~HSV enters human host through inoculation of oral, genital, or conjunctival mucosa or break in skin
1.Intrauterine 2. Perinatal 3. Postnatal
Lethargy Poor feeding Fever Irritability
skin
-Usually presents in the first two weeks of life
-clustering vesicular lesions with an erythematous base
Eyes-