What is Herpes in Newborns?
Herpes in newborns is a severe viral infection that is transmitted to the newborn from a sick mother and provokes serious disorders in the functioning of the brain, liver, lungs and skin. Herpes in newborns is caused by herpes simplex viruses types 1 and 2.
Causes of Herpes in Newborns
Viruses of the Herpetoviridae family, DNA viruses, 8 types of which are pathogenic for humans. The fetal route of infection is hematogenous (15-20%) in the case of viremia (virus infection through the blood) and ascending (through the cervix and membranes of the ovum; 80%).
More than 90% of people are infected with the herpes simplex virus and 20% of them have clinical manifestations of the 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 having a baby with neonatal herpes when passing through an infected birth canal is 20-60%. In the structure of intrauterine infections, it occupies 10-12%.
Pathogenesis during Herpes in Newborns
The virus multiplies intracellularly, mainly in the amnion epithelium (a temporary extra-fetal organ that creates a fluid medium for the developing fetus). Cells undergo small block decomposition. The process in the central nervous system is characterized as necrotic meningoencephalitis with foci of necrosis in the frontal lobes of the brain and subependymal zones.
Virusemia during pregnancy causes up to 30% of spontaneous abortions in the early stages, more than 50% of late miscarriages; when infected at the 20-34th week of pregnancy, premature birth occurs in 30% of cases. Herpes simplex virus takes 2nd place after rubella virus in teratogenicity, contributes to habitual miscarriage.
There are several clinical forms:
- Localized form.
- Disseminated (generalized); secrete a special variant of infection – herpetic infection of the newborn.
- Latent form.
Symptoms of Herpes in Newborns
The symptoms of herpes in newborns are characterized by the appearance of a rash in the form of small vesicles filled with fluid. If the infection has penetrated deeply or treatment has not been started on time, the following symptoms will be added to the symptoms: temperature fluctuations, drowsiness, cramps, decreased muscle tone.
The clinical picture of perinatal herpetic infection depends on the time of infection, the risk of manifest forms increases with a prolonged anhydrous period of childbirth and the use of invasive procedures. 70% of newborns become 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 birth.
- Manifestation of a herpetic infection in a newborn within 14 days of life (less often by the end of the 1st month). It appears as:
– a severe disseminated disease involving the central nervous system, lungs, skin, mucous membranes of the mouth and eyes, with the development of hemorrhagic syndrome. Mortality 50-80%;
– common mucocutaneous changes (dermatitis, stomatitis, keratitis). Mortality up to 30%;
– meningoencephalitis, in the clinical picture of which intoxication dominates, cerebral and local syndromes. The virus selectively damages the frontotemporal lobes of the brain with hemorrhagic and necrotic changes. Mortality 50-80%.
- Subclinical variant of herpetic infection of the newborn.
- Intrauterine infection with the formation of fetal malformations (microcephaly, porencephaly).
Diagnosis of Herpes in Newborns
Diagnosis of herpes in a newborn includes an examination by a doctor with an infectious disease specialist, who will prescribe a number of diagnostic procedures for the patient to confirm the infection and determine the depth of its penetration:
- Virological method: the presence of the virion, the genome of the virus and its antigens in the contents of the vesicles, smear impressions from the mucous membranes, biopsy specimens of internal organs.
- An accelerated method of culturing the virus, followed by the use of monoclonal antibodies for indication.
- Molecular hybridization and PCR methods.
- Cytological and cytochemical methods.
- Linked immunosorbent assay.
Herpes Treatment in Newborns
In the treatment of herpes in newborns, vidarabine (30 mg / kg per day intravenously drip daily for 10-14 days) or acyclovir in combination with infusion therapy and anticonvulsants are used.
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.
In case of primary infection (herpetic eruptions during pregnancy 1 month before childbirth) or recurrence of infection (2 weeks before childbirth), delivery should be performed by caesarean section, until the membranes rupture. If there is a history of genital herpes in the mother and her husband, a laboratory study of scrapings from the cervical canal before childbirth is recommended (preferably by polymerase chain reaction). If a herpes simplex virus type 2 is detected in the scraping, delivery is carried out by cesarean section. If, during a laboratory examination of pregnancy in the I-III trimesters, herpes simplex viruses are determined in a scraping from the cervical canal, in the presence of a burdened history and complicated pregnancy, specific therapy is advisable.
In the case of spontaneous birth, with late recognition of herpetic eruptions, daily for the first 3 days, a newborn takes smears from the eyes, mouth and skin to detect the herpes simplex virus, after 1 month, a similar study is carried out with an interval of 7 days.
Antiviral drugs are used in newborns who are infected by mothers who have had primary genital herpes shortly before delivery, who could not have had a cesarean section or the operation was performed 4-6 hours after rupture of the fetal bladder. In other cases, it is recommended that the baby take smears from the conjunctiva and from the nasopharynx 24-36 hours after birth. The herpes simplex virus does not pass into breast milk, so a woman can naturally feed her.
Herpes Prevention in Newborns
Since the newborn is infected by the herpes virus from the mother, the disease is prevented with a pregnant or planning woman.
In order for the mother to avoid infection with genital herpes (herpes type 2), it is worthwhile to take measures to prevent STDs. In the 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), immunostimulating therapy (drugs that increase immunity) and vaccination with an inactivated herpetic vaccine are used.