Prevention and management of neonatal herpes simplex virus infections

Area of Science:

• Neonatal infectious diseases
• Virology
• Public health policy

Background:

• Neonatal herpes simplex virus (HSV) infection can lead to severe outcomes, including death and long-term disability.
• All newborns are susceptible to HSV infection, with intrapartum transmission being a significant concern.
• Existing guidelines require updating to reflect current understanding and management strategies.

Purpose of the Study:

• To review the epidemiology, transmission, and risk factors of neonatal HSV infection, focusing on intrapartum transmission.
• To provide updated recommendations for the diagnosis, prognosis, and management of neonatal HSV infection and exposure.
• To offer guidance for empirical management of infants with suspected sepsis, including those unresponsive to antibiotics.

Main Methods:

• Review of existing literature on neonatal HSV infection.
• Expert opinion synthesis for management recommendations, as randomized controlled trials are not feasible.
• Analysis of diagnostic modalities and their limitations.

Main Results:

• Detailed review of HSV epidemiology, transmission routes, and risk factors, particularly intrapartum.
• Categorization of diagnosis and prognosis based on infection type.
• Evidence-based and expert-opinion-driven recommendations for management of exposed and infected neonates.

Conclusions:

• Updated guidance is crucial for managing neonatal HSV infection and exposure.
• Expert opinion is essential for developing management strategies in the absence of definitive clinical trials.
• This statement replaces the 2006 Canadian Paediatric Society guidelines, offering contemporary recommendations.