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Limitations in the immunologic response predispose the infant to certain viral and bacterial infections acquired during the prenatal, perinatal and immediate postpartum period. The development of the immune system, and the mechanisms of response to both bacterial infection are discussed in Chapter 186. Common perinatal viral and bacterial infections are discussed in this chapter.

Viral pathogens can infect the fetus or neonate in utero via transplacental or ascending transmission of microorganisms, the peripartum period at delivery by passage through an infected birth canal, or the postpartum period by acquisition within the first several weeks of life. Human cytomegalovirus (HCMV) and rubella virus can cause significant sequelae when acquired in utero, whereas herpes simplex virus types 1 and 2 (HSV-1, HSV-2) and enteroviruses can cause life-threatening disease when acquired in the peripartum and postpartum periods.

The usual mode of transmission, clinical presentations, diagnosis and treatment of common neonatal viral infections are discussed in the following section and summarized in Table 230-1.

Table 230-1. Neonatal Viral Pathogens and Treatment

Herpes Simplex Virus

Herpes simplex virus (HSV) infections can be acquired in utero (5%), peripartum (85%), or postpartum (10%). Peripartum or postpartum disease can be classified as disseminated disease involving multiple visceral organs, including lung, liver, adrenal glands, skin, eye, and/or the brain (disseminated disease); central nervous system disease, with or without skin lesions (CNS disease); and disease limited to the skin, eyes, and/or mouth (SEM disease). This classification system is predictive of both morbidity and mortality.1-5 Patients with disseminated or SEM disease generally present to medical attention at 10 to 12 days of life, and ...

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