Does your little one have herpes? Let's learn about neonatal herpes!

Have you noticed a few small blisters on your newborn baby's body that are making you a little worried? Or do you feel like your baby is having trouble feeding or breathing? Sometimes, these can be signs of a condition called Neonatal Herpes, which can affect newborns. This is very different from herpes in adults, and it can be a little more dangerous for babies. So, without further ado, let's talk about this in detail.

What is Neonatal Herpes?

Simply put, neonatal herpes is a herpes infection that occurs within the first six weeks of a baby's birth. It most commonly occurs when the herpes simplex virus (HSV) is passed from mother to baby, especially during childbirth.

This is not like herpes (for example, cold sores on the lips) that older children or adults get. This virus is very dangerous for newborn babies, and can sometimes be life-threatening. This is because this virus can affect the baby's major organs, especially the brain . Therefore, it is very important to recognize the symptoms and treat them as soon as possible. Only then will the baby have a better chance of recovery.

In countries like the United States, the condition affects between 5 and 33 children per 100,000 live births. That means about 1,500 babies are born with herpes this way every year. Some research suggests that this number has increased slightly recently, but the exact reason for this is still unclear.

What are the main types of this condition?

Doctors classify neonatal herpes based on which parts of the baby's body the virus has affected. There are three main types:

1. Skin, eye and mouth disease (SEM disease): This causes fluid-filled blisters to form on the baby's skin, inside the mouth, and around the eyes .

2. Central nervous system disease (CNS disease - brain disease): Here the virus grows and multiplies in the baby's central nervous system, that is, the brain and spinal cord . Sometimes, there may be no symptoms in the early stages, and no skin blisters may appear.

3. Disseminated disease: In this case, the virus affects many parts of the baby's body, including major organs like the liver and lungs . In some cases, the brain can also be affected.

Imagine how difficult this must be for a little baby. That's why we need to be aware of this.

What are the signs that your baby has herpes?

The most obvious symptom is often fluid-filled blisters that appear on the baby's skin, around the eyes, and in the mouth . However, not all babies get these blisters. It depends on the type of herpes the baby has.

These symptoms can appear anytime within the first six weeks after the baby is born.It can occur, but it is most likely to occur within the first four weeks. Some things, such as blisters, baby not breastfeeding, difficulty breathing, and changes in baby's behavior, you may notice at home. If you notice anything like this, you should see a doctor immediately. But there are some symptoms that can only be detected during a medical examination.

If the baby is having difficulty breathing, or if you are unable to wake the baby, call 1990 immediately or go to the nearest emergency room.

Symptoms of skin, eye, and mouth disease (SEM disease)

These usually appear between 9 and 11 days after the baby is born.

• Clear, fluid-filled blisters on your baby's skin. The skin around these blisters may be discolored. The blisters may also form clusters.
• Fluid-filled blisters on or around your baby's eyelids . Your baby's eyes may be red, watery, and swollen.
• Sores inside the baby's mouth, on the tongue and palate .

Symptoms of central nervous system disease (CNS disease)

These usually appear between 16 and 19 days after the baby is born.

• Excessive sleepiness.
• Constant restlessness and irritability.
• Shaking.
• Lack or no interest in drinking milk.
• Unstable body temperature (too high or too low).
• The soft spots on the baby's skull are bulging.
• Seizures.
• Fluid-filled blisters on the skin. About 60% - 70% of babies with this type of disease develop these blisters.

Symptoms of disseminated disease

These usually appear between 10 and 12 days after the baby is born. You may notice the following signs in your baby:

• Unstable body temperature (too high or too low).
• Constant restlessness and irritability.
• Excessive sleepiness.
• Lack or no interest in drinking milk.
• Rapid breathing and changes in breathing pattern (respiratory distress).
• Abdominal bloating.
• Fluid-filled blisters on the skin. About 60% of babies with this type of disease develop these blisters, but only after the infection has become more severe.

Symptoms that can be detected through medical tests:

• Blood clotting problems (disseminated intravascular coagulation).
• Liver failure.
• Brain swelling (encephalitis).
• Inflammation of the heart muscle (myocarditis).

What causes herpes in newborns?

Neonatal herpes is caused by the herpes simplex virus (HSV) .Because their immune systems are not yet fully developed, they can become very sick from this HSV virus.

How is herpes transmitted to newborns?

Most often (85%) the virus is transmitted from mother to baby during childbirth . This can happen if the virus is active in the mother's genital area when the baby comes through the birth canal.

Although less common (about 10%), a baby can also become infected after being exposed to the virus after birth. For example, if a person with cold sores on the lips kisses the baby . Or if a person with a herpes infection on the skin (herpetic whitlow) touches the baby.

There is a very small chance (about 5%) that the virus will pass to the fetus during pregnancy . Doctors call this an intrauterine infection . This means that the HSV virus passes through the placenta to the fetus. If this happens, the typical symptoms of herpes in newborns can be seen within 48 hours of the baby being born. Sometimes, this intrauterine infection can also cause miscarriages.

Risk factors for transmission during childbirth

HSV can only be transmitted during childbirth if you have an active genital herpes infection at the time. Importantly, you can have an active infection even if you have no symptoms . The virus can be present in your genital tract (such as the vagina and cervix) even if you don't have any symptoms.

Research shows that your risk can vary greatly depending on when you first develop a herpes infection:

• During pregnancy (if you have not been previously exposed to herpes): If you develop genital herpes for the first time during pregnancy, especially in the second trimester, close to delivery, you are at the highest risk of transmitting herpes to your baby. Doctors call this a primary first episode . This is when you develop genital herpes with one of the two HSV subtypes (HSV-1 or HSV-2), and you have no prior exposure to the other subtype. This means that the HSV virus has entered your body for the first time, and you do not have antibodies against either type. If you develop this primary infection late in pregnancy, the virus is much more likely to be present in your baby’s genitals at the time of delivery.

• During pregnancy (if you have been previously exposed to another HSV subtype): This means that you develop a genital herpes infection with one HSV subtype for the first time during pregnancy, but you have antibodies against it due to previous exposure to the other subtype. Research shows that there is still a significant risk of transmitting the virus to your baby, but the risk may be lower than for someone who has never been exposed to HSV. This is because your previous antibodies pass through the placenta to your baby, providing some protection.

• Before pregnancy: If you had genital herpes before you became pregnant, the risk of passing the virus to your baby is low. The virus needs to reactivate during delivery (recurrent infection) to be transmitted to your baby. Although HSV can reactivate, research shows that a re-infection during pregnancy is much less likely to cause neonatal herpes than a first infection. This is because antibodies from your past infection pass on to your baby and protect him.

Why is herpes in newborns a dangerous condition?

Neonatal herpes is a dangerous condition because it can damage the baby's organs, especially the brain . For example, it can cause swelling of the baby's brain (herpetic encephalitis) . Even with treatment, neonatal herpes can sometimes be fatal.

Skin, eye, and mouth disease (SEM) does not initially affect the baby's brain or internal organs. But it is still dangerous because it can cause permanent eye damage and even blindness . If left untreated, SEM can progress to a brain disease (CNS disease) or disseminated disease.

How to diagnose herpes in newborns?

Doctors diagnose neonatal herpes by reviewing the baby's symptoms and performing tests. They want to rule out other conditions that can cause similar symptoms. For example, there's a common (and harmless) condition called erythema toxicum neonatorum , which also causes a skin rash and fluid-filled blisters.

If doctors suspect herpes, they immediately test the baby to see if the herpes simplex virus is present in the baby's body.

What other tests should be done for my baby?

A doctor will collect fluid samples from your baby's body. This will involve using a swab to carefully take samples from these areas of your baby's body:

• By mouth.
• With eyes.
• From the throat (the upper part called the nasopharynx).
• Through the anus.
• If there are blisters, from those blisters.

Your baby's doctor may also collect these samples:

• Blood.
• Cerebrospinal fluid (CSF) . This is a fluid taken from the baby's spine. This requires a lumbar puncture .

Lab testing

The baby's doctor will send these samples to a laboratory for testing. Tests that may be done include:

• Viral culture test: This uses special techniques to grow the HSV virus in a fluid sample. If there is no sign of growth after five days, doctors usually consider the test negative (HSV is not present).
• PCR (Polymerase Chain Reaction) test:This test looks for the DNA of the herpes simplex virus in body fluids. Doctors often use cerebrospinal fluid samples for this test to see if the virus has affected the baby's central nervous system.

Other types of tests

If lab tests confirm that your baby has herpes, your baby's medical team will likely also do these tests:

• Chest X-ray examination.
• Abdominal X-ray examination.
• Brain imaging, like an MRI scan (magnetic resonance imaging scan).
• Detailed eye exam.

All of this helps doctors learn more about how the virus has affected different parts of the baby's body. They use this information to develop a treatment plan for the baby.

What are the treatments for herpes in newborns?

If doctors suspect that your baby has neonatal herpes, they will likely hospitalize the baby for treatment .

Doctors use an antiviral drug called acyclovir to treat herpes in newborns. Your baby will be given this medication through a vein (IV) and then as a liquid (oral) to take . Here's what you can expect:

• If your baby has skin, eye, and mouth disease (SEM) , they will need 14 days of IV treatment. After that, they will need to complete a six-month course of oral medication. This will reduce the risk of the skin blisters coming back.
• If your baby has a central nervous system (CNS) disease or disseminated disease , they will need IV treatment for 21 days. After the IV treatment is finished, your baby will need to take oral medication for six months. This helps support your baby's nerve development and reduces the risk of long-term effects on the brain.

It is important to know that some babies with CNS-related conditions may need IV treatment for more than 21 days. A CNS-related condition is when a cerebrospinal fluid (CSF) test shows the presence of HSV virus in the baby's cerebrospinal fluid. This can be due to either CNS disease or disseminated disease.

If so, the baby will need to have a follow-up spinal tap to make sure the virus has completely cleared from the brain. The test must be negative before IV treatment can be stopped. Some babies may take another week or longer to clear the virus from the brain. Only then can they start oral treatment.

What is the outlook for a baby with herpes?

Your baby's outlook depends on many factors. For example, the type of herpes your baby has and how well treatment controls the virus. Your baby's medical team can tell you exactly what to expect in the near and long term. Most babies with neonatal herpes recover . However, in some cases, the condition can be fatal.

Thanks to antiviral drugs, more babies are surviving today than ever before. Today, 71% of babies with disseminated disease and 96% of babies with CNS disease survive to at least their first birthday.

Herpes in newborns can sometimes cause long-term effects, including:

• Developmental delay ( delay in reaching developmental milestones by the expected time).
• Intellectual disability.
• Cerebral palsy (weakness in movements).
• Epilepsy.

The good news is that early intervention (activities and services tailored to each child's needs) and ongoing support can help your child. For example, your child may benefit from physical therapy, speech therapy, and assistive technologies (such as screen readers).

Can herpes in newborns be prevented?

Doctors are doing everything they can to prevent herpes in newborns. Here's what you need to know:

• Antiviral medications can help: If you've had genital herpes before, your doctor may prescribe antiviral medications to take during the last few weeks of your pregnancy. This can reduce the risk of the infection coming back during labor and may also allow for a lower-risk vaginal birth.
• A cesarean section (C-section) may be safer: Sometimes doctors recommend a cesarean section if the benefits outweigh the risks. For example, they will likely perform a cesarean section if you have an active infection at the time of delivery. In that case, the baby is at a higher risk of infection than if you were to have a vaginal birth. So, a cesarean section is safer.
• Doctors make changes during delivery: If you are having a vaginal birth, your doctor may change what equipment they use for your baby. For example, they may not use a fetal scalp monitor because it can cause small breaks in your baby's skin. When your baby has a break in their skin, it is easier for the HSV virus to enter and cause an infection. Doctors will decide which equipment to use and which not to use based on your baby's risk of infection.
• You and your doctor are on the same team: Talking to your doctor about sex isn’t always easy. It can be uncomfortable, and it can even feel like something you don’t want to do. But talking to your doctor about ways to prevent genital herpes can help protect you and your baby. For example, if you’re at risk for a new herpes infection, your doctor may advise you to limit or stop sexual activity during the last three months of pregnancy. First exposure to HSV-1 or HSV-2 during late pregnancy is the main risk factor for newborn herpes.

When should I see a doctor?

If your baby has any of the symptoms of neonatal herpes, see a doctor right away . Neonatal herpes needs prompt treatment. The sooner your baby gets treatment, the better the chance of survival and recovery with minimal or no long-term effects. Don't wait until your baby's next well-check.

Can babies get cold sores on their lips?

Yes. Babies can get cold sores on their lips if they are exposed to the herpes simplex virus (HSV). This virus can make newborn babies very sick. If you think your baby has been exposed or if they are showing symptoms, see a doctor.

Can someone with herpes have a baby?

It definitely is. People with a history of genital herpes give birth to healthy babies. In fact, if you have a diagnosis of genital herpes, you are more likely to have a baby without the virus causing any problems. This is because recurrent herpes infections are less likely to cause neonatal herpes than a first-time infection.

However, it's important to talk to your doctor about your medical history so they can take the necessary precautions during pregnancy and childbirth.

You may have prepared for a lot of things, but you probably didn't expect something like this. A diagnosis of herpes in a newborn can be a shock, especially if you didn't think it was possible. Deal with this situation day by day, maybe hour by hour.

Most babies respond well to treatment. Medical science has advanced a lot over time, so there is plenty of reason to be hopeful.

If you're feeling scared or overwhelmed, get support from your baby's medical team. They can help you understand the next steps in treatment and what to expect from day to day.

Let's remember the most important things (Take-Home Message)

• Neonatal herpes is a potentially very dangerous infection for babies.
• It is often transmitted from mother to baby during childbirth .
• Baby's skin blisters, excessive sleepiness, not breastfeeding, breathing difficultiesIf you see symptoms like this, seek medical advice immediately .
• Prompt treatment can save the baby's life and reduce long-term complications.
• If you have herpes, it's very important to talk to your doctor about it during pregnancy so that you can take steps to prevent passing the disease to your baby.
• Don't worry , with proper medical treatment and your love and care, many babies recover.

Remember, you are not alone. The doctors are there to help you and your baby. So talk to them about anything.

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