Thread by @EM3FOAMed

We would like to share a story about Baby B. Baby B died at only 11 days of age from #neonatalHSV and we have been working closely with her family to improve awareness in our trust. [1/16]

Baby B is her parent’s first baby. Born following an uncomplicated pregnancy, with no risk factors for infection and discharged home within a few hours. She was reviewed on day 5 by the midwife. She had lost 12% of her birthweight and was referred into hospital for review. [2/16]

Baby B had been bottle fed from birth. She was managing 30-60mls but it took a long time. Parents commented she was sleeping 90% of the time and she slept through her ED examination. There was no fever, no rash and (apart from breathing quickly) her examination was normal. [3/16]

It was decided to take some bloods, order a chest x-ray and to admit. Her CRP was raised and the x-ray showed some changes so she was started on antibiotics for sepsis. Baby B remained very sleepy and started to have pauses in her breathing. She was admitted to the PICU. [4/16]

On PICU she was ventilated for a short while. Blood markers of infection were improving and HSV PCR from her lumbar puncture was negative. Because she was so sleepy she had metabolic tests sent. Her ALT was high, doctors assumed this was due to her resolving sepsis. [5/16]

Baby B was extubated and was breathing on her own. She was getting ready to go to the ward when staff noticed she was oozing excessively from a heel prick site. She had repeat bloods taken to check her clotting and liver function. [6/16]

These came back very abnormal – showing liver failure and coagulopathy. She was immediately discussed with the regional liver unit. Review of the notes at this time found a comment that Baby B’s mum was worried she had cold sores. [7/16]

Baby B sadly died from disseminated HSV infection at 11 days of life. Her story has touched all who knew and met her during her time in her short life. [8/16]

Her family have met with us and are keen for her legacy to be that ALL health care professionals (HCP’s) seeing neonates #ThinkHSV and investigate and treat appropriately. [9/16]

Some facts…

Neonatal HSV is relatively rare with an incidence of 6.9 per 100,000 live births in the UK.

40% of babies with disseminated HSV do NOT have skin lesions.

A raised ALT can be an early sign of disseminated HSV.

#ThinkHSV [10/16]

Some facts… (cont.)

HSV can be passed from genital, orofacial or skin (i.e. herpetic whitlows).

50% of mothers with genital HSV NEVER experience symptoms.

Viral swabs should be taken from skin, throat, blood and CSF for herpes PCR.

#ThinkHSV [11/16]

We have produced a poster locally with information for healthcare professionals – Baby B’s photo features on the poster and (PLEASE NOTE) this is of her on a ventilator and some people may find it distressing. [12/16]

We have also produced a local learning bulletin highlighting the work of the @KitTarka organisation. [13/16]

Please check that you are…

Giving new parents information on the dangers of HSV infection ✅

Ensuring that if HSV is in your differential ALL swabs (blood, CSF, skin & throat) are negative before stopping treatment ✅

[14/16]

Please check that you are… (cont.)

Listening to parents – numbers need context and they are the ones who can provide this ✅

Keep an open mind – sometimes we treat the wrong thing for all the right reasons. If the clinical picture doesn’t add up, think again ✅

[15/16]

Finally, thank you to Baby B’s family who have allowed us to share her story ❤️

Contact @EM3FOAMed if you'd like a version of our poster to share in your trust.

Please also see the great work of @KitTarka & (later this year) @BLA_campaign who are focusing on #ThinkHSV

[16/16]