目的:描述新生儿疱疹的流行病学及其危险因素,临床和肩关节旁表现,为有新生儿疱疹风险的新生儿提出指导方针,描述治疗方式,描述产后传播及其预防。
方法:来自Medline的书目搜索,Cochrane图书馆数据库和国际临床实践指南的研究。
结果:新生儿疱疹很少见(法国每年约20例),主要是由于HSV1(证据水平LE3)。母婴传播的主要危险因素是接近分娩的生殖器疱疹的母体原发性发作和血清型HSV1(LE3)。新生儿疱疹有三种临床形式:皮肤的SEM感染,眼睛和粘膜,中枢神经系统(CNS)相关感染,和传播感染。神经系统死亡率和发病率取决于临床形式和HSV血清型(LE3)。在大多数新生儿疱疹病例中,母亲没有生殖器疱疹(LE3)病史。在诊断时可能不存在发热和水疱性皮疹(LE3)。如果怀疑新生儿疱疹,必须进行HSVPCR的不同样本(血液和脑脊液)以确认诊断(专业共识)。任何怀疑新生儿疱疹的新生儿应在HSVPCR结果之前静脉注射阿昔洛韦(A级)治疗(专业共识)。在分娩时发生母体生殖器疱疹的情况下,无症状新生儿的管理取决于对传播风险的评估。在产妇再激活(低传播风险)的情况下,在生命的24小时采集HSVPCR样品,必须密切关注新生儿,直到结果。在母体原发发作或非原发感染首次发作(传播风险高)的情况下,在生命24小时时取样,并开始使用阿昔洛韦进行静脉内治疗(专业共识)。新生儿疱疹的治疗基于静脉阿昔洛韦(60mg/kg/天,分为3次注射)(C级)。治疗的持续时间取决于临床形式(SEM感染为14天,其他表格21天)(专业共识)。建议每个操作系统(300mg/m2/天)的阿昔洛韦继电器6个月,以改善神经系统预后并降低再激活的风险(B级)。产后传播主要是由于HSV1。父母和家人必须了解预防产后传播的规则,也由护理人员(专业共识)。在母亲疱疹的情况下,母乳喂养不是禁忌的,除非乳头上有疱疹性病变(专业共识)。有新生儿疱疹风险的新生儿的父母应在出院后在家接受有关临床体征的信息(专业共识)。
结论:新生儿疱疹是一种罕见的疾病,具有很高的发病率和死亡率。对处于危险中的新生儿的管理需要产科和儿科团队以及父母的信息之间的良好协调。
OBJECTIVE: To describe the epidemiology of neonatal herpes and its risk factors, clinical and paraclinic manifestations, propose
guidelines for a newborn at risk of neonatal herpes, describe treatment modalities, describe post-natal transmission and its prevention.
METHODS: Bibliographic search from Medline, Cochrane Library databases and research of international clinical practice
guidelines.
RESULTS: Neonatal herpes is rare (about 20 cases per year in France) and mainly due to HSV 1 (level of evidence LE3). The main risk factors for mother-to-child transmission are maternal primary episode of genital herpes close to delivery and serotype HSV 1 (LE3). There are three clinical forms of neonatal herpes : SEM infection for skin, eyes and mucosa, central nervous system (CNS) associated infection, and the disseminated infection. Neurological mortality and morbidity depend on the clinical form and the HSV serotype (LE3). In most of the case of neonatal herpes, the mothers have no history of genital herpes (LE3). Fever and vesicular rash may be absent at the time of diagnosis (LE3). In case of suspicion of neonatal herpes, different samples (blood and cerebrospinal fluid) for HSV PCR must be carried out to confirm the diagnosis (Professional
consensus). Any newborn suspected of neonatal herpes should be treated with intravenous aciclovir (Grade A) prior to the results of HSV PCR (Professional
consensus). In case of maternal genital herpes at delivery, the management of an asymptomatic newborn depends on the evaluation of the risk of transmission. In case of maternal reactivation (low risk of transmission), HSV PCR samples are taken at 24hours of life and the newborn must be follow closely until results. In the case of maternal primary episode or non-primary infection first episode (high risk of transmission), the samples are taken at 24hours of life and intravenous treatment with aciclovir is started (Professional consensus). The treatment of neonatal herpes is based on intravenous aciclovir (60mg/kg/day divided into 3 injections) (Grade C). The duration of the treatment depends on the clinical form (14 days for the SEM infection, 21 days for the other forms) (Professional consensus). A relay with aciclovir per os (300mg/m2/day) for 6 months is recommended to improve the neurological outcome and reduce the risk of reactivation (grade B). Post-natal transmission is mainly due to HSV 1. The rules for the prevention of post-natal transmission must be known by parents and family, but also by nursing staff (Professional
consensus). Breastfeeding is not contraindicated in cases of maternal herpes, except if there is herpetic lesion on the nipple (Professional consensus). Parents of newborns at risk for neonatal herpes should receive information on the clinical signs to be monitored at home after hospital discharge (Professional consensus).
CONCLUSIONS: Neonatal herpes is a rare disease with a high morbidity and mortality. The management of a newborn at risk requires good coordination between the obstetric and pediatric teams and parent\'s information.