Consensus preventie van herpes neonatorum

W.I. van der Meijden en A.M. Dumas

Consensus meeting on prevention of neonatal herpes.

- On 16th January 1987, a consensus meeting on the prevention of neonatal herpes was held in Rotterdam.

The most important conclusion of this meeting was that screening for herpes simplex virus (HSV) of pregnant women ‘at risk’, starting between week 32 and 36 of pregnancy, should not be performed as a routine. Instead, cultures have to be taken (1) during delivery, from the cervix and the usual location of the recurrence and (2) after delivery from the child (oropharynx).

Among those present, there was general consensus on the proposition that pregnant women ‘at risk’, not showing manifest herpetic lesions, should be allowed normal vaginal delivery. No consensus was reached concerning patients with a recurrence. Major considerations to accept a vaginal delivery in both situations are:

1. Only 1-2 of pregnant women with recurring genital herpes asymptomatically shed the virus during delivery.

2. Neonatal herpes occurs in only 2-4 of neonates exposed to the virus during delivery.

3. Antiviral therapy is available (i.e. aciclovir).

4. The results of viral cultures can be available within the incubation period (i.e. within four days).

Everyone agreed that a Caesarean section is indicated in the case of an extensive, and thus possibly primary, herpetic infection during the last two weeks of pregnancy. No consensus was reached on the proposal of the organizing committee, to give prophylactic treatment with aciclovir to neonates in the case of positive viral cultures in mother and (or) child.