Neonatal Sepsis can be life threatening and can become fatal if not quickly and properly treated. Med League neonatal nurse expert witness was retained on a case involving Neonatal Sepsis resulted in a wrongful death case that involved Herpes Simplex Virus. Neonatal sepsis occurs when a child develops sepsis within a few months of birth (up to 90 days).

If the sepsis develops within 24 hours of birth, it is called early onset. Sepsis that develops after delivery is called late-onset neonatal sepsis.

Case Scenario:

Infant demise at 7 days of age with diagnosis of septic shock related to systemic herpes infection.  Blistered lesion on scalp on day 2 was erroneously felt to be caused by internal fetal monitor, however, infant was monitored externally.

History of positive GBS with premature onset of labor and rupture of membranes with chorioamnionitis were risks for late onset neonatal sepsis.   Infant was placed on ampicillin, gentamicin and nafcillin.

Attempts to recover Infant were unsuccessful.  He continued to deteriorate from severe sepsis related to herpes simplex virus.  Infant developed septic shock, severe metabolic acidosis, DIC (Disseminated intravascular Coagulation), respiratory failure, decreased urine output despite volume support, Epinephrine, Dopamine and Vasotec.

Infant developed severe hyponatremia and Hyperkalemia for which he was given HCO2 and Ca gluconate, FFP and Cryo for his DIC.

HSV Neonatal Sepsis

Herpes Simplex Virus (HSV)

There are two types of HSV:

1.) HSV type 1: usually associated with infections of the lips, mouth, and face and is spread by infected saliva, via the infection site or toys, cups, cosmetics, etc. Most cases are acquired in childhood. HSV-1 often causes lesions inside or around the mouth, such as cold sores (fever blisters). Individuals with a cold sore should avoid contact with newborn infants. Caregivers with a cold sore should wear a surgical mask and scrupulously wash their hands.

2.) HSV type 2: is sexually transmitted. Symptoms include genital ulcers or sores. The virus can also lead to complications such as infection of the lining of the brain and the brain itself (meningoencephalitis or infection of the eye (especially the conjunctiva and cornea). Cross-infection of type 1 and 2 viruses may occur from oral-genital contact. The herpes virus can infect the fetus and cause abnormalities.

Sepsis Diagnosis in Neonatal

Diagnosis of herpes can be made on the basis of the appearance or culture of the lesion. Examination may also show enlargement of lymph nodes in the neck or groin. Laboratory tests, including spinal fluid and urine cultures, may also be used.

Signs and Symptoms of Neonatal Sepsis

• Body temperature changes
• Breathing problems
• Diarrhea
• Low blood sugar
• Reduced movements
• Reduced sucking
• Seizures
• Slow heart rate
• Swollen belly
• Vomiting
• Yellow skin and whites of the eyes (jaundice)
• Neonatal Sepsis

Pregnancy Precautions

A mother who is infected with herpes may transmit the virus to her newborn during vaginal delivery, especially if she has an active infection at the time of delivery. It’s possible for the virus to be transmitted even when there are no symptoms or visible sores.

If you are pregnant and have a history or signs and symptoms of genital HSV-2 infection, tell your doctor as soon as possible. A C-section delivery is recommended if a mother has an HSV-2 outbreak near the time of birth.

Late Onset Neonatal Sepsis

Neonatal Sepsis

Risk Factors

• Mom is positive for group B Streptococcus infection during pregnancy
• The baby is premature
• The membranes rupture (water breaks) more than 24 hours before the baby is delivered.
• Exposure to people who have contagious infections.

Common Infections That Cause Neonatal Sepsis

• Herpes simplex virus
• Respiratory syncytial virus (RSV)
• Cytomegalovirus (CMV)
• Escherichia Coli (E Coli)
• Candida
• Listeria monocytogenes

Treatments

There is no cure for herpes simplex virus, but there is treatment of its symptoms. Herpes virus infections in infants are generally treated with intravenous medications.

Acyclovir is the most common antiviral medicine used for this purpose. A course of several weeks may be required. Infants with systemic herpes or encephalitis frequently have poor outcomes despite antiviral medications and early intervention. Infants with the skin disease may have recurrences after therapy is finished.

If you are an attorney working on a case involving neonatal sepsis, call us today to retain an expert who can identify and assist to review your client’s records and be available to testify at deposition and trial if needed.

Med League provides medical expert witnesses to trial lawyers. Please call us at (908)788-8227 or contact us today to discuss your next case.

References:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/herpes-hsv1-and-hsv2/birthacquired-herpes
https://www.sepsis.org/