Neonatal Herpes Infection: A Review

Leslie A. Parker, MSN, RNC, NNP; Sheryl J. Montrowl, MSN, RNC, NNP

Disclosures

NAINR. 2004;4(1) 

In This Article

Prognosis

HSV infection in the newborn period can be a significant source of mortality and morbidity. The prognosis of HSV infection is related to classification of the disease and the early initiation of treatment. Before antiviral therapy, mortality was 50% for CNS disease and 85% for disseminated disease. With the use of high dose acyclovir therapy, mortality decreased to 4% for CNS disease and to 29% for disseminated disease.[2] The mortality rate of SEM disease is 0% unless diagnosis and treatment is delayed.[41] Failure to recognize and treat SEM disease can quickly progress to CNS and/or disseminated disease. Other predictors of mortality include prematurity, pneumontitis, DIC, and coma.[6]

Although there have been great strides in the diagnosis and treatment of HSV infection in the newborn, this disease continues to be associated with significant long-term sequalae, including learning disabilities, cerebral palsy, blindness, and persistent seizures.[2,20,29] Kimberlin and coworkers[2] reported that, with the use of high dose acyclovir, normal development at 12 months occurred in 98% of infants with SEM disease, 30% with CNS disease, and 75% with disseminated disease. Among the patients diagnosed with CNS disease, seizures at initiation of treatment and the detection of HSV DNA by PCR analysis in the CSF following treatment significantly increases the incidence of abnormal development.[2,31]

There is a direct correlation between development of neurological deficits and frequency of cutaneous HSV recurrences.[19,29] The use of suppressive oral acyclovir at 300 mg/m2 three times per day for the first six months decreases the risk of reoccurrence. However, at this time there are no data to support an improved prognosis and therefore the use of suppressive therapy should only be used as an investigational therapy.[40] In addition, although antiviral therapy is the only current treatment for HSV infection, the development of a vaccine and/or passive immunotherapy is currently under investigation.

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