LAS VEGAS — Most cases of disseminated neonatal herpes and CNS neonatal herpes do not present with skin lesions, Dr. M. Jeffrey Maisels noted at a meeting sponsored by the American Academy of Pediatrics' California Chapters 1, 2, 3, and 4 and the AAP.
“You can't rely on seeing a herpetic looking vesicle on a baby's skin to tip you off that the baby might have systemic herpes or CNS neonatal herpes,” said Dr. Maisels, who chairs the department of pediatrics at William Beaumont Hospital, Royal Oak, Mich.
The chief complaint in cases of disseminated neonatal herpes is decreased activity—the so-called “quiet baby”—in the first 2 weeks of life, as well as decreased oral intake and some respiratory distress. Physical exam may reveal hypothermia, lethargy, and/or hypoperfusion. Tachypnea and seizures may occur.
“When you do the lab tests these babies commonly have metabolic acidosis,” said Dr. Maisels, also of Wayne State University, Detroit. They commonly come in with severe thrombocytopenia and severe coagulopathy. They have liver involvement, renal involvement, and hypoglycemia.
Treatment involves acyclovir 60 mg/kg per day as well as intensive care and management of the coagulopathy, which usually consists of multiple transfusions with fresh frozen plasma, cryoprecipitate, packed red blood cells, and platelets. “This condition has a high mortality: 56%–90%, and it is close to 100% if they come in with severe shock or coma,” Dr. Maisels said.
In cases of CNS neonatal herpes, which typically occurs between birth and 6 weeks of life, the chief complaints are decreased feeding and slowly progressive lethargy.