Pediatric emergency medicine trisk 2478 2478
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FIGURE 96.6 Neonatal acne. (Courtesy of Amy Ross, MD. In: Chung EK, Atkinson-McEvoy
LR, Boom JA, et al., eds. Visual diagnosis and Treatment in Pediatrics . 2nd ed. Philadelphia,
PA: Lippincott Williams & Wilkins; 2010. With permission.)
Significant Neonatal Rashes (See Chapter 69 Rash: Neonatal
)
HSV Infection
HSV is the most important condition to consider when evaluating a vesicular
eruption because of its significant associated morbidity and mortality.
Current Evidence. Most neonatal HSV infections are caused by HSV type 2.
While transplacental transmission can rarely occur, most neonatal HSV disease is
acquired perinatally from infection of the maternal genitourinary tract. Primary
maternal infection at the time of delivery is associated with a 40% to 50% chance
of transmission but most neonates with HSV are born to mothers who did not
provide a history of HSV infection or other identifiable risk factors.
Clinical Considerations. Goals of treatment: early diagnosis and prompt
initiation of antiviral therapy to decrease morbidity and mortality.
Clinical Recognition. The infant can appear well at birth but become ill at days 4
to 7, at which time a vesicular eruption may be noted ( Fig. 96.7 ). The most
common lesions are small vesicles on an erythematous base which may become
