[Modalities of treatment local and general, medicamentous or not, controlling neonate suspected to be infected/contaminated by HSV1 or HSV2].
Neonatal herpes infection is secondary to pre/perinatal viral contamination from mother by HSV2 (70 p. 100) or HSV1 (30 p. 100). Incidence in French population is closed to 3/100,000 live births corresponding to 20 cases per year. Risk for maternal viral transmission to the neonate is 30 p. 100 with genital herpetic primo infection and 3 p. 100 in recurrence. However, in 70 p. 100 of cases, maternal history is not contributive. Three main clinical presentations are described However atypical symptoms - as isolated fever - can be a telltale sign. Mean clinical delay from birth to first clinical symptoms is 6 to 12 days and neonate is usually symptom - free at birth. Viral cultures from pharynx, stools, cutaneous lesions and specific PCR in blood and cerebrospinal fluid confirm the diagnosis. Curative treatment is acyclovir at high dosage - 60 mg/kg/d - during 14 days for localized forms and 21 days for neurological and disseminated diseases. Compared to conventional dosages, this treatment leads to a reduction in mortality which however remains high in disseminated forms, 31 p. 100 and 6 to 11 p. 100 in CNS infection. Morbidity is also high in survived patients, 17 p. 100 and 31 p. 100 respectively. Efficacy of prophylactic viral decontamination by anti-herpetic eye drops and cutaneous polyvidone iodine bath, which is largely used at birth in France, has never been evaluated.
Service de Néonatologie, Hôpital Robert-Debré, Paris, France.
Y
Y
Aujard
D000212:Acyclovir / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005602:France; D006561:Herpes Simplex / Q000175:diagnosis / Q000628:therapy*; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000628:therapy*; D011206:Povidone-Iodine / Q000008:administration & dosage; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000628:therapy*
D000891:Anti-Infective Agents, Local; D000998:Antiviral Agents; D011206:Povidone-Iodine; D000212:Acyclovir