Neonatal herpes

[worriedandrestless]

Grace, I work in a NICU and needless 2 say it makes me worry so much more. I am 30 y old female and learned i have HSV 2 almost 7 months ago, Very mild symptoms if any at all. I have taken care of 2 babies from the same mother at different times where both babies were born C-section and both born with CP "due to undetermined cause" I thought that if you avoided vaginal contact during birth that there was no risk to infant. My question is this, Is there any way that hsv2 can be systemic? Is there anything you have read to support such an outcome? I worry so much about that thinking about family planning in the near future. One more question....can one take valtrex throughout the whole pregnancy or just at the last couple of weeks prior to delivery? and is it worth taking if C-section is scheduled.

[gracefromHHP]

I totally agree - the chances that CP was from hsv2 in these babies is incredibly small. Not sure how long you've worked in nicu ( or the size of your nicu ) but CP is pretty common and it's not just associated with neonatal herpes. You also know that when a baby is admitted to nicu , if they show any signs of infection, a thorough work up is done, including a spinal tap and culturing of the eyes and such for herpes and other causes.  

we joke at work that when it's time for someone to have a baby there, every child with a genetic defect in the tri-state area will be admitted within a month of their due date....lol.    It drives you INSANE with worry!!  Right now you are focused on neonatal herpes but I guarantee you that when you do become pregnant, you'll see the oddest stuff out there to make you paranoid about way many other things .  It's like nursing school - you convince yourself you have a wheat allergy, a brain tumor and omg my feet swell because I have kidney disease ( and not because you have been on them for 12 hours...lol ).  the risk of transmission of hsv2 to a baby with no lesions present is less than 1%. Since you have hsv2 prior to pregnancy, it's only a risk for you during delivery.  If you happen to have lots of ob's or one near your due date and a c section is decided for by you and your provider, a planned c section is not a risk to the baby. If your amniotic fluid is still intact, no way for herpes to get to your baby when it's not a newly acquired infection for you.  

the herpes antivirals are in the same pregnancy category as tylenol.  Current recommendations are to just treat ob's as they occur unless decided otherwise by your provider. Many providers do allow daily suppressive therapy throughout pregnancy. we have no info to show that it's not safe ( though no studies that say that it is - clear as mud? ).  the valtrex/acyclovir and pregnancy registeries show less incidence of birth defects than the average rate ( which is 3% ).   A study done fairly recently showed that suppressive therapy in the last month of pregnancy is safe for mom and baby.  

So when you are pregnant, you know where to come :)  Meanwhile keep on loving those babies at work and reminding yourself that half the babies you care for wouldn't be there if the momma's took better care of themselves and had proper prenatal follow up - both things you already know how to do well I"m sure :)  There will always be babies who need nicu's and thankfully most of them are there for better safe than sorry reasons ( the routine work ups most of them get because of issues with delivery or a fever or lethargy etc ) or just to feed and grow because they were born too early.  You know that for most of them , everything turns out well. If you work in even a small 16 bed unit for instance, you know that statistically 4 of their momma's have hsv2 and hsv2 isn't the reason they are in there.  

grace

[sadgirl789]

Hi there,

I'm not Grace but....have been doing quite a bit of reading on this subject with great interest.

I'm assuming that the woman you're talking about with the 2 children with CP has HSV 2.  As far as I understand, CP is not connected to neonatal herpes--it's a separate condition altogether.  The CP is most likely a result of something else...not herpes. Isn't it linked to a lack of oxygen at birth?  That is not herpes.  Neonatal herpes is sooooooooooooooooooo rare, affecting only 1 in 5500 women with an established infection, perhaps even less, depending where you are from.  In Canada it's 1 in 10 000 and in Europe even less.  This means at the very least  a 99.9% chance of NOT affecting the baby.  Relax and don't worry.....

Also, as far as I understand, Valtrex (or suppressive therapy) is recommended for the final four weeks of pregnancy.  It's not generally recommended to take daily throughout pregnancy, unless indicated by your doctor.  Don't assume you need a C-section as a result of HSV.....a vaginal birth is much preferable in the absence of lesions, which is likely the case with suppressive therapy the final four weeks of pregnancy.  It's totally not a big deal, based on my reading....if you openly share this info with your doctor.....Don't worry about the very UNREALISTIC chance of neonatal herpes.  For some reason, it's been blown way out of proportion.  The real risk is to women who acquire the infection during pregnancy. You already know you have the infection and have the antibodies, which are passed onto to the baby.   Take care of yourself :)