tailieunhanh - INFECTIOUS DISEASES - PART 6

Bởi vì các nguy cơ cho trẻ sơ sinh tiếp xúc với tổn thương HSV trong thời gian giao hàng khác nhau trong những hoàn cảnh khác nhau từ ít hơn 5% đến 50% hoặc nhiều hơn, các quyết định điều trị trẻ sơ sinh tiếp xúc với không có triệu chứng thực nghiệm với tĩnh mạch acyclovir là gây tranh cãi. | unknown. Acyclovir is not approved by the FDA for this indication. Care of Newborn Infants Whose Mothers Have Active Genital Lesions. By Vaginal Delivery. Because the risk to infants exposed to HSV lesions during delivery varies in different circumstances from less than 5 to 50 or more the decision to treat the asymptomatic exposed infant empirically with intravenous acyclovir is controversial. Because the infection rate of infants born to mothers with active recurrent genital herpes infections is less than 5 most experts would not treat these infants empirically with acyclovir. The infant s parents or caregivers however should be educated about the signs and symptoms of neonatal HSV infection. For infants born to mothers with a primary genital infection the risk of infection may exceed 50 . Because of this high infection rate some experts recommend empiric acyclovir treatment at birth after HSV cultures have been obtained and others would obtain HSV cultures 24 to 48 hours after delivery and initiate acyclovir therapy only if HSV is recovered from these cultures. If the infant has clinical findings suggestive of HSV infection such as skin or scalp rashes especially vesicular lesions or unexplained manifestations such as those of sepsis cultures should be obtained regardless of age and acyclovir therapy should be initiated immediately. The accuracy of viral cultures for predicting neonatal infection in infants whose mothers were treated with antiviral medication during pregnancy is not known. Differentiating primary genital infection from recurrent HSV infection in the mother would be helpful for assessing the risk of HSV infection for the exposed infant but the distinction may be difficult. First-episode clinical infections are not always primary infections. Often primary infections are asymptomatic in which case the first symptomatic episode will represent a reactivated recurrent infection. In selected instances serologic testing can be useful. For example if a .