I was recently looking at a thread on social media under a video of a grandma kissing all over a newborn’s face. The comments were absolutely full of misinformation about the risks of this. It was precious and while I completely understand the feelings associated with it, we should talk about the risk to the newborn.

The newborn immune system and infection

Newborns have an underdeveloped immune system for the first 2-3 months of life. Their blood-brain barrier is also not fully protective yet. Therefore we consider fever (defined as 100.4º F or 38º C) to be an emergency until around 3 months of age. Newborns are susceptible to both viral and bacterial infections. These infections can enter their body via multiple routes, including via respiratory droplets, via breaks in their skin, and through the mucous membranes or the GI tract. This can happen during the process of birth, or from exposure later. When a newborn gets a fever, depending on the exact age, symptoms and presentation, they will likely need blood work, a catheterized urine specimen and a spinal tap for a workup possibly followed by hospitalization for observation and IV antibiotics/antivirals.

Why is HSV such a big deal to a newborn?

One of the infections that makes pediatricians especially nervous is herpes virus infections. It is also referred to as HSV. The comments on the post that I am speaking about made it obvious to me that people need a little more information on this topic. 

There are two types of HSV, type 1 and type 2. Either type can appear in any location on the body, but the classic association is with type 1 on the mouth area and type 2 on the genital area. In any age individual, the first outbreak usually results in a large number of painful, fluid filled blisters and in most, fever. Later outbreaks are usually less severe but still can be quite painful. It tends to recur in our bodies in times of stress or immune system compromise. 

Enter the newborn. With their compromised immune state and weak blood-brain barrier, they are more susceptible to picking up this virus at the time of delivery or afterwards from a family member’s kiss. Obstetricians watch for this and tend to put women on antiviral medications around their deliveries if they have known HSV in the genital area. If they have active lesions in that area when delivery time comes, they will often perform a cesarean section in order to reduce the risk to the baby. 

Facts about HSV infection

In the US, the prevalence of HSV in either form is around 25% of the population. HSV virus remains dormant in the nerve root of the area infected permanently. There are many people that got it as a young child and have never had any more symptoms. It can also be sexually transmitted and the person infected does not have any symptoms.Many times, when someone is either carrying or shedding the virus, they are completely unaware that they can spread it. Combine this with the fact that it is often carried on lips and that people kiss newborns with those lips increases the risk that the newborn may contract the virus. 

The incidence of neonatal (first 30 days after birth) HSV infection in the US is around 1/3500 live births. Around 10% of those come from the lips of someone that has kissed them. While this number is relatively small, it is still a possibility.  Since the infection can be so devastating neurologically, we want to do as much as we can to avoid this.

If you are having a baby,what can you do?

• Make sure you are aware of your HSV status. If you have never had a cold sore or a genital lesion, the odds are low that you are a carrier. If you want to be extra safe, there is a blood test that can be done to determine your status. It checks for antibodies to the virus.

• Have good boundaries with your newborn and ask that family members avoid kissing them until they are a little older. It helps if they know their status, but still probably safer to wait. As long as the family member is well, holding the baby and touching them is fine.

• Careful hand washing is always important, but especially when dealing with a newborn.

• After the newborn is 30 days of age, they can still get the virus from kissing, but the risk to their brain and life is much lower. 

• There are antiviral medications that can reduce shedding of the virus, and if you are a carrier, you may want to ask your doctor about taking daily meds for the first few weeks of your baby’s life to reduce the risk of infection. 
  
  

In closing, your newborn is very vulnerable the first few weeks of their life. To avoid potentially catastrophic results, caution is advised. 

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