Prevention & Management of Neonate HSV Infections - CPS Statement Flashcards
What are the three types of maternal HSV infection?
Newly acquired:
1) First-episode primary infection (mother has no serum antibodies to HSV-1 or -2 at onset);
2) First-episode non-primary infection (mother has a new infection with one HSV type in the presence of antibodies to the other type)
Recurrent:
1) Mother has pre-existing antibodies to the HSV type that is isolated from the genital tract
Which type of maternal HSV infection provides the highest risk of transmission to the infant?
First-episode primary infection
What is the timeframe for presentation of neonatal HSV?
Up to 42 days
Typically presents within the first 4 weeks of life, but can be up to 6 weeks
A repeat CSF PCR within ___ hours of starting acyclocir is likely to be positive in infants with CNS HSV
72 hours
Why is infant serology not useful in diagnosing neonatal HSV?
1) Transplacental immunoglobulin (Ig) G antibodies cannot be differentiated from IgG produced by the infant.
2) The ability of some severely affected infants to make antibodies is impaired. 3) The commercially available assays for HSV IgM antibodies have only variable and limited reliability.
What are the three types of neonatal HSV?
1) Disseminated HSV
2) Localized CNS HSV
3) Skin, eye and mucous membrane (SEM) infection
What is the duration of acyclovir treatment for each type of neonatal HSV?
SEM disease: duration of therapy is 14 days
Disseminated or CNS disease: minimum duration of treatment is 21 days.
What are the two potential side effects of high-dose acyclovir?
Neutropenia
Nephrotoxicity
When evaluating NHSV infection in exposed asymptomatic infants, mucous membrane swabs should be obtained from the mouth, nasopharynx and conjunctivae at least ___ after delivery
24 hours
What should you do with an infant of a mother with first-episode genital lesions at a delivery, but born via C/S with no ROM?
Mucous membrane swabs at 24 hrs of life
No tx unless swabs positive or clinical signs
**Some experts recommend full workup still
What do you do in the situation of first clinical episode of genital herpes infection, when an infant is delivered vaginally or by Caesarean section after rupture of membranes?
Mucous membrane swabs +/- blood
Start acyclovir x10 days at least
If swabs positive -> collect CSF
What do you do in the situation of recurrent HSV at delivery–Infant delivered by Caesarean section?
Mucous membrane swabs at 24 hrs of life
No tx unless swabs positive or clinical signs
Some experts recommend full workup still
What do you do in the situation of recurrent HSV at delivery–Infant delivered vaginally?
Obtain mucous membrane swabs at 24 h and the infant may be discharged pending results.
No tx unless swabs positive or clinical signs of HSV
What do you do when managing asymptomatic term infants whose mothers have no active lesions at delivery (including women on ACV prophylaxis)?
An infant whose mother has a history of HSV but no active lesions at delivery should be observed for signs of NHSV but does not require ACV therapy. Mucous membrane swabs are not routinely recommended for this infant
What is the treatment dose of IV acyclovir?
60 mg/kg/day in three divided doses administered every 8 h
