Viral Infections in the Nursery

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.