Neonatal herpes simplex infection: Keys to early diagnosis

Objective: To highlight the clinical features of neonatal herpes simplex (HSV) infection that might facilitate earlier diagnosis. Methodology Fifteen year retrospective review of proven neonatal HSV cases from a regional neonatal referral unit. Results Fifteen cases reviewed: 10 with central nervous system (CNS) disease, three with skin, eyes or mouth (SEM) disease and two with disseminated disease (DIS). A median 4 day delay occurred between symptom onset and hospital admission. All cases presented after maternity hospital discharge, most commonly with feeding problems and lethargy. Six patients presented with skin lesions; parental genital herpes was reported in three (20%) cases. Seven infants died, four without acyclovir treatment and three of 11 treated cases. Three of five CNS disease survivors and all infants with SEM disease were normal at follow up. Conclusions Acyclovir improves outcome in neonatal HSV infection. To improve outcome further earlier recognition of the non-specific presenting features of the disease is required.