What is Herpes in newborns
Herpes in newborns is a serious viral infection that is transmitted to a newborn from a sick mother and provokes serious disruptions in the work of the brain, liver, lungs and skin. Herpes in newborns cause herpes simplex virus types 1 and 2.
Causes of Herpes in newborns
Viruses of the Herpetoviridae family, DNA viruses, 8 types of which are pathogenic to humans. The path of infection of the fetus is hematogenous (15-20%) in the case of viremia (infection by viruses through the blood) and ascending (through the cervix and membranes of the fetal egg, 80%).
More than 90% of people are infected with herpes simplex virus and 20% of them have clinical manifestations of infection. The risk of developing herpes in newborns is 75% in the case of acute genital herpes in the mother, with a recurrent course of 3-5%.
The risk of the birth of a child with neonatal herpes when passing through infected birth canal is 20-60%. In the structure of intrauterine infections takes 10-12%.
Herpes pathogenesis in newborns
The virus multiplies intracellularly, mainly in the epithelium of the amnion (a temporary extraembryonic organ that creates a liquid medium for the developing fetus). The cells undergo a shallow-smiled decomposition. The process in the central nervous system is characterized as necrotizing meningoencephalitis with foci of necrosis in the frontal lobes of the brain and subependimal zones.
Viralemia in pregnancy causes up to 30% of spontaneous abortions in the early stages, more than 50% of late miscarriages; at infection on 20-34th week of pregnancy in 30% of cases there are premature births. Herpes simplex virus ranks second after rubella virus in terms of teratogenicity, contributes to the habitual miscarriage of pregnancy.
There are several clinical forms:
- Localized form.
- Disseminated (generalized); a special variant of infection is isolated – a herpetic infection of the newborn.
- Latent form.
Symptoms of Herpes in newborns
Symptoms of herpes in newborns are characterized by the appearance of rashes in the form of small bubbles filled with liquid. If the infection has penetrated deeply or the treatment was not started on time to the symptoms will be added: temperature fluctuations, drowsiness, convulsions, decreased muscle tone.
The clinical picture of perinatal herpetic infection depends on the time of infection, the risk of manifest forms increases with the long anhydrous period of labor and the use of invasive manipulation. 70% of newborns are infected from mothers with latent infection. The child is most at risk of infection with the development of a primary infection in the mother a month before the birth.
- Manifestation of herpetic infection in a newborn during 14 days of life (less often by the end of the first month). It appears as:
– severe disseminated disease involving the central nervous system, lungs, skin, mucous membranes of the mouth and eyes, with the development of hemorrhagic syndrome. Mortality rate is 50-80%;
– common skin-mucous changes (dermatitis, stomatitis, keratitis). Mortality up to 30%;
– meningoencephalitis, whose clinical picture is dominated by intoxication, cerebral and local syndromes. The virus selectively damages the frontal-temporal lobes of the brain with hemorrhagic and necrotic changes. Mortality rate is 50-80%.
- Subclinical variant of herpetic infection of newborns.
- Intrauterine infection with the formation of malformations of the fetus (microcephaly, porencephaly).
Diagnosis of Herpes in newborns
Diagnosis of herpes in a newborn includes, examination by a doctor infectious disease specialist who, in order to confirm infection and determine the depth of her penetration, will assign a number of diagnostic procedures to the patient:
- Virological method: the presence of a virion, the genome of the virus and its antigens in the contents of vesicles, smears-prints from mucous membranes, bioptata of internal organs.
- Accelerated method of culturing the virus followed by the use of monoclonal antibodies for indication.
- Methods of molecular hybridization and PCR.
- Cytological and cytochemical methods.
- Linked immunosorbent assay.
Treatment of Herpes in newborns
In the treatment of herpes in newborns are used vidarabine (30 mg / kg per day intravenously drip every day 10-14 days) or acyclovir in combination with infusion therapy and anticonvulsant drugs.
With meningoencephalitis, the drug of choice is acyclovir, intravenously. Vidarabine (15 mg / kg intravenously) in combination with cytarabine (3-5 mg / kg intravenously) 1-2 times a day for 3-5 days.
For primary infection (herpetic eruptions during pregnancy 1 month before childbirth) or relapse of infection (2 weeks before delivery), delivery should be performed by caesarean section, before rupture of membranes. In the presence of genital herpes in the mother and her husband, a laboratory examination of scrapings from the cervical canal before birth (preferably by the polymerase chain reaction method) is recommended in the anamnesis. If a DNA virus of type 2 herpes simplex is found in the scrap, the delivery should be performed by caesarean section. If laboratory tests of pregnancy in I-III trimesters in a scrapie from the cervical canal determine herpes simplex virus, in the presence of a history of complications and a complicated course of pregnancy, specific therapy is appropriate.
In the case of spontaneous childbirth, with late detection of herpetic eruptions, every day for the first 3 days, the newborn is taken smears from the eyes, mouth and skin to detect the herpes simplex virus, after 1 month, a similar study is carried out at intervals of 7 days.
Antiviral drugs are used in newborns who have contracted from mothers who underwent primary genital herpes shortly before birth, who could not have had a cesarean section or the operation was performed 4-6 hours after rupture of the bladder. In other cases, the child is recommended to take smears from the conjunctiva and from the nasopharynx 24 to 36 hours after birth. Herpes simplex virus does not penetrate into breast milk, so a woman can naturally nurse.
Prophylaxis of Herpes in newborns
Since the herpes virus infects the newborn from the mother, prevent the disease with a pregnant woman or a woman who plans to conceive.
To prevent the mother from getting infected with genital herpes (herpes of type 2), it is worthwhile to take measures to prevent STDs. In case of prevention of infection of a woman with herpes simplex virus type 1, viral and respiratory diseases should be avoided.
If the infection is secondary (repeated), immunostimulatory therapy (immunity-enhancing drugs) and vaccination with inactivated herpetic vaccine are used.