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be classified into the following categories: disseminated disease, central nervous
system (CNS) disease, or skin, eye, and/or mouth (SEM) disease. A high index of
suspicion is necessary in neonates presenting with vesicles or pustules, especially
with a negative bacterial culture. About 40% of neonatal herpes is confined to the
SEM. Most infections acquired during the peripartum period present between 9
and 11 days of life, though they can be seen earlier or later. Those infants with
SEM disease are most easily diagnosed since they usually present with obvious
vesicular lesions. HSV that develops in the skin usually begins as papules or
vesicles that erode. Erosions may be the only visible lesions. They usually have a
red base and are 1 to 3 mm in diameter and can occur as a single unit or in
clusters ( Fig. 69.7 ). They appear anywhere on the body but are most commonly
seen on the presenting parts such as the head in vertex presentation and buttocks
in breach. Scalp probe sites can become sites of primary infection. The poorest
outcome is in infants who present with widespread disease involving lungs, liver,
adrenal gland, skin, eyes, and mouth. Infants presenting with disseminated herpes
disease typically present with symptoms very similar to those associated with
bacterial infection. Although the diagnosis may be easily confused, disseminated
herpes disease may often be distinguishable from bacterial infection by the
presence of vesicular lesions, neonatal hepatitis of unknown etiology, and DIC.
Disseminated herpes infection may have CNS involvement and the infant may
therefore exhibit symptoms consistent with encephalitis or meningitis. The
highest risk of developing neonatal HSV occurs when the mother has true
primary infection at the time of delivery; the risk for developing neonatal herpes
is about 30%. The risk for transmission in infants born to mothers with known
genital herpes is less than 1%, which may be related to transfer of maternal HSV
IgG antibodies across the placenta.


FIGURE 69.2 Infant with papules and pustules of erythema toxicum on the face.

FIGURE 69.3 Multiple collarets of scale on the leg of a newborn with TNPM.


FIGURE 69.4 Skin peeling on the trunk of infant with staphylococcal scalded skin syndrome.