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Viral Infections in the Nursery

  • Asif Noor
  • Theresa M. Fiorito
  • Leonard R. Krilov
Chapter

Abstract

Viral infections seen in the newborn nursery may be acquired in utero or during delivery. Presentations range from asymptomatic to severe multi-organ system involvement. Common viral infections encountered in the newborn nursery include cytomegalovirus (CMV), human immunodeficiency virus (HIV), herpes simplex virus (HSV), hepatitis B virus, Zika virus, and parvovirus B19. A series of case vignettes, including an approach for the clinician, is presented in this chapter.

The initial workup is focused on identifying maternal exposure and the newborn’s risk of infection. It includes obtaining a history of chronic maternal infections (HIV, hepatitis B), acute illnesses during pregnancy or delivery (CMV, HSV), travel during pregnancy (Zika), interpretation of maternal labs, and initiation of newborn workup.

CMV is the most common congenital infection and is diagnosed with polymerase chain reaction assay (PCR) on urine or saliva in the first 3 weeks of life. HIV-exposed newborns should be started on antiretroviral therapy within 6–12 h of life, and HIV DNA PCR should be sent for testing. All newborns should receive hepatitis B vaccine within 24 h of life, and if maternal hepatitis B surface antigen is positive, hepatitis B immunoglobulin should be given within 12 h of life. In an asymptomatic newborn born to a mother with active genital HSV lesions, HSV surface cultures and PCR should be sent at 24 h of life. The decision to do a further workup and start acyclovir is based on symptomatology and HSV test results. Travel to a Zika endemic region during pregnancy and maternal labs suggestive of definitive or probable Zika infection should prompt collaboration with the local Department of Health and neonatal testing for Zika infection.

Keywords

Virus Viral infection Cytomegalovirus (CMV) Human immunodeficiency virus (HIV) Herpes simplex virus (HSV) Hepatitis B virus Zika virus Parvovirus B19 

References

  1. 1.
    American Academy of Pediatrics. Cytomegalovirus. In: Kimberlin DW, editor. Red book: 2015 report of the committee on infectious diseases. 30th ed. Elk Grove: American Academy of Pediatrics; 2015.Google Scholar
  2. 2.
    CDC: Congenital CMV Infection. https://www.cdc.gov/cmv/congenital-infection.html. Accessed August, 2017.
  3. 3.
    Rawlinson WD, Boppana SB, Fowler KB, et al. Congenital CMV infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. 2017;17(6):e177–88.CrossRefGoogle Scholar
  4. 4.
    Kimberlin DW, Jester PM, Sanchez PJ, et al. Valganciclovir for symptomatic congenital CMV disease. N Engl J Med. 2015;372(10):933–43.CrossRefGoogle Scholar
  5. 5.
    Postpartum Care Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States: Initial Postnatal Management of the HIV-Exposed Neonate. https://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/188/initial-postnatal-management-of-the-hiv-exposed-neonate. Accessed August, 2017.
  6. 6.
  7. 7.
    American Academy of Pediatrics. HIV infection. In: Kimberlin DW, editor. Red Book: 2015 report of the committee on infectious diseases. 30th ed. Elk Grove: American Academy of Pediatrics; 2015.Google Scholar
  8. 8.
    CDC: Zika virus: Healthcare Providers Caring for Infants and Children. https://www.cdc.gov/zika/hc-providers/infants-children.html. Accessed August, 2017.
  9. 9.
    Kimberlin DW, Baley J. Committee on infectious diseases; committee on fetus and newborn. Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Pediatrics. 2013;131(2):e635–46.CrossRefGoogle Scholar
  10. 10.
    American Academy of Pediatrics. Herpes simplex. In: Kimberlin DW, editor. Red Book: 2015 report of the committee on infectious diseases. 30th ed. Elk Grove: American Academy of Pediatrics; 2015.Google Scholar
  11. 11.
    American Academy of Pediatrics. Hepatitis B. In: Kimberlin DW, editor. Red Book: 2015 report of the committee on infectious diseases. 30th ed. Elk Grove: American Academy of Pediatrics; 2015.Google Scholar
  12. 12.
    Centers for Disease Control and Prevention. A comprehensive immunization strategy to eliminate transmission of hepatititis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP); Part 1 : immunizatoion of infants, children and adolescents. MMWR. 2005;54(RR–16).Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Asif Noor
    • 1
  • Theresa M. Fiorito
    • 1
  • Leonard R. Krilov
    • 1
    • 2
  1. 1.Department of PediatricsChildren’s Medical Center at NYU Winthrop HospitalMineolaUSA
  2. 2.Department of Pediatrics State University of New York at Stony Brook School of MedicineStony BrookUSA

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