Herpes neonatorum is an infection with a baby’s herpes virus in the first four weeks of life. It is a rare condition; it occurs in one in 35,000 newborn children. There are two types of the herpes virus:
- type I: in older children and adults especially blisters on the face (fever rash)
- type II: gives blisters on the genitals
In three out of four babies, type I is the cause of the herpes neonatorum. Often the infection is transmitted by a kiss from someone with a fever rash. More information about herpes type I can be found in the information leaflet ‘Cold sore’. More information about herpes type II can be found in the information leaflet ‘Herpes genitalis’.
Herpes neonatorum is an infection with a baby’s herpes virus
How do you recognize herpes neonatorum?
The first signs of an infection with the herpes virus arise about five days after the infection. Only half of the children have typical cold sores. This makes herpes sometimes difficult to recognize. There are three forms of herpes neonatorum:
- infection of the skin and mucous membranes
- brain infection
Infection of the skin and mucous membranes An infection of the skin and mucous membranes can be recognized by the presence of groups of vesicles. These blisters appear on the skin, on the mouth or around the eyes, and are filled with moisture. After a few days, the blisters dry out and crusts develop.
Infection of the brain In infection of the brain, your child becomes restless and irritated. Your child cries a lot and cannot be comforted. After that, it becomes more and more dull, until it stops responding at some point. Seizures can also occur, with jerking of arms and legs and turning of the eyes. Your child often has a fever.
Blood poisoning With blood poisoning, your child often starts drinking badly and pee less. It also gets a supportive and groaning breath. Often there is a fever and your child may vomit. The skin may develop a strong yellow discoloration and bleed under the skin may occur. In addition, your child may become gray and eventually no longer respond to addressing.
How does herpes neonatorum develop?
The newborn can become infected with the herpes virus at different times and in different ways.
Infection before or during delivery When the mother is infected with the herpes virus and herpes suffers during delivery (this does not always have to be with visible blisters), the virus can be passed on to the child during delivery. This usually concerns herpes type II. The herpes infection can also rise with broken membranes and infect the child.
Infection after birth Usually, however, the infection occurs after birth. Someone with herpes blisters on the lip or nose hugs the child. Herpes virus is contained in the fluid of the vesicles and when it comes into contact with the child, it becomes infected with the virus.
In the Netherlands, many (seven out of ten) people are infected with the herpes virus, but not all of these people also have blisters. These people do have antibodies against the herpes virus. The baby receives antibodies against the herpes virus through the placenta before birth or through breast milk. As a result, the infection can be limited to the skin and mucous membranes. If the antibodies are not enough, the herpes virus can more easily infect the brain or cause blood poisoning.
Is it serious and what can you expect?
Prognosis The severity of the herpes virus infection depends on whether or not antibodies are present in the baby. The baby can get these antibodies from the mother during pregnancy, but only if the mother has had a repeated infection with the herpes virus.
A herpes virus infection in a baby without antibodies is a serious illness. If the virus is limited to the skin and mucous membranes, the prognosis is favorable. Brain infection or blood poisoning are serious conditions. Without treatment, five out of ten children die from brain infection and nine out of ten children with blood poisoning.
Treatment When herpes neonatorum in newborns is recognized in time, the child can be treated with medicines that kill the virus through an IV. This can prevent complications and death, especially if the herpes virus has not yet caused blood poisoning. Despite drugs, one in ten children with a brain infection and seven out of 10 with blood poisoning still die.
Prevention is better than cure Preventing herpes infection in the newborn is therefore very important.
Residual symptoms When surviving after cerebral inflammation, the chance of permanent brain damage is high. This is reflected in the developmental delay, ranging from learning difficulties to dementia. Furthermore, many behavioral problems also occur, such as aggressiveness, hyperactivity and impulsivity.
When to the doctor?
If you suspect that your child has symptoms related to a herpes infection, contact your doctor. The GP will examine your child and refer you to the hospital if he suspects your child has this condition.
What can you do about it yourself?
Herpes is contagious from the formation of the blisters to the formation of a scab on the blisters.
Precautions If you, your partner or your visit have a fever rash, it is important to take the following precautions:
- do not scratch the blisters or scabs
- always wash your hands before picking up or changing the baby
- wear a mouth mask if you have a fever rash on the lip
- do not kiss your child if you have a fever rash on the lip
- do not allow toiletries and food and drink items from a person with a fever rash to come into contact with others
- wear gloves if you have a fever on your fingers
Breastfeeding You may breastfeed if you have a fever rash yourself, but you must also wear a mask. Only if you have cold sores on or around the nipple, you should not feed your child with that breast. It is advisable to express that breast to prevent engorgement. After that, boil the part of the flask that has come into contact with the breast and discard the expressed milk.
Treatment If you or your partner have a fever rash, you can treat this with aciclovir ointment. This can often prevent blisters from forming and shortens the period of infectivity. The sooner you start doing this, the better. The effect of starting if you have had blisters for four days or more is questionable.
General advice and precautions
Reporting If you or your partner have suffered from herpes vesicles on the genitals, it is very important to report this to the midwife or gynecologist. Even if you do not have blisters during delivery, you can still transmit the virus to your child. Fortunately, this rarely happens: one to two in a hundred women who are familiar with herpes vesicles on the labia transmit it to her child during labor.
Cultivation In order to detect the virus at an early stage, cultures are taken from the cervix and vagina during delivery. Also, after your baby is born, cultures are taken from the mouth and throat. It is examined whether the herpes virus is in these cultures. If that is the case, your child will be given medicines directed against the herpes virus as a precaution. In this way, contamination can be prevented. It is not necessary to do a cesarean section as a precaution.
Caesarean section This only happens when you first become infected with the herpes virus during the last weeks of pregnancy and you have blisters on the labia or cervix, which can still be contagious during delivery.
Antibodies It takes a while before you make antibodies against the herpes virus that are also passed on to the baby before birth. When you have blisters on the labia or cervix for the second or more times during delivery, you have already passed on the antibodies to your child. There is therefore no reason to do a cesarean section. Your child will be treated as a precaution.
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