• Anita Verma, Anil Dhawan, Mark Zuckerman, Nedim Hadzic, Alastair J Baker, and Giorgina Mieli-Vergani.
• Department of Medical Microbiology and Virology, Health Protection Agency, London, King's College Hospital, London, UK. anita.verma@kingsch.nhs.uk
• J. Pediatr. Gastroenterol. Nutr. 2006 Mar 1; 42 (3): 282-6.

BackgroundAcute liver failure (ALF) in neonates is rare but carries a high mortality without liver transplantation. Herpes simplex virus (HSV) is one of the microbes that more commonly causes ALF and is potentially treatable; hence, early diagnosis and treatment are important to avoid progression to liver failure.Patients And ResultsWe have analysed retrospectively the case notes of 11 patients with HSV-induced ALF. A history of possible herpes infection was elicited in 5 parents, but HSV had not been suspected clinically. All patients were asymptomatic when discharged from postnatal units and were presented with nonspecific symptoms of poor feeding and lethargy within 2 weeks from birth. Seven of the 11 patients had HSV-1 infection, 4 HSV-2. Only 2 patients who received early treatment with intravenous acyclovir survived.ConclusionsHSV-related ALF in the neonatal period carries high morbidity and mortality and needs a high index of suspicion so that life-saving treatment can be started promptly. Both HSV-1 and HSV-2 can cause severe neonatal infection. It is important to recognise HSV infection in women of childbearing age and their sexual partners.

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