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Babies and Infectious Diseases: A Hug Away

by Sue Hubbard, M.D.

I had a really unusual case last week.  It is interesting now because all is well, but during this baby’s evaluation there was much concern on everyone’s part.

This baby was about 2 and a half weeks old and he had been a perfectly healthy newborn, and I had actually seen him several times due to some slow weight gain and jaundice. All of that resolved and he was fine, when a day later he developed a rash on the upper part of his chest and beneath his armpit.  The mother had never seen the few “spots” before, (seemed that they had popped up overnight), and 2-3 were already scabbed over. The baby was feeding fine, had not had a fever but she decided to bring him in.

He was seen and we all agreed that he looked well, but sent him to see the pediatric dermatologist to see what she thought.  The few scabbed lesions looked like impetigo, but there was one that was vesicular and there was concern that it had remote chance of being herpetic (there was NO history of herpes in the mother etc.)  Again, this precious baby was oblivious. He was happy to breast feed and snuggle with an almost “what’s the fuss about?” attitude.

So….cultures were taken, he was started on some antibiotics for a suspected impetigo skin infection and was  sent home.

He was doing well when.  7 days later his culture report turns up positive for herpes!!!  Again, this baby appears perfectly fine, and by now the lesions in question are all gone. I have to call the parents with the news and I also had to consult my infectious disease buddies as to what to do.

After many doctors weighed in on the subject of neonatal herpes, which can be quite serious in the immediate newborn period, a decision was made to admit the baby for further workup.

Now, if you read even more about neonatal herpes, it can cause serious problems and including brain injury and death if a baby contracts herpes from the mother during delivery etc.

But, the biggest issue for this very sweet family is that they thought their baby was just fine, and now a week later I am calling them to tell them we have to put their “seemingly” healthy newborn in the hospital for a spinal tap, blood work, MRI of the brain and more!!!  To watch their perfectly blissful, new parent faces dissolve into tears is just incredibly difficult. Trying to reassure anxious parents is a job that pediatricians have to do, but sometimes it is harder than others.

Now, (long story short) after an anxious 36 hours all of the baby’s tests came back negative.  The more I looked at this baby the more I believed that he contracted a herpetic skin rash from someone who had picked him up (as it was in the perfect distribution of a hand beneath the armpit) who probably unknowingly had herpes on their hand.

I will never be sure, but this taught me another lesson.  I am continuing to learn from my patients and their families and in this case, I learned all sorts of new things about viruses, probably more than I will ever need to know (as I must have consulted 10 other doctors). I also learned, washing hands is still the most important thing we can keep doing!

That’s your daily dose.  We’ll chat again tomorrow.

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