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Textbook/Paediatrics and child health/Congenital infection and newborn prophylaxis/Rapid

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Congenital infection and newborn prophylaxis

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2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending

Sepsis, vesicles, hepatitis or encephalitis in an exposed newborn

Vesicular lesions, seizures, respiratory failure, shock, coagulopathy, hepatitis, severe thrombocytopenia or rapidly deteriorating illness can represent disseminated HSV or another congenital or perinatal infection.

Action: Stabilise ABC, temperature and glucose; obtain blood and CSF samples when safe without delaying treatment. Start IV aciclovir immediately when neonatal HSV is suspected and give empirical antibacterial therapy when sepsis remains possible. Involve neonatal infection, microbiology and the relevant maternal team. Check renal function and hydration, take HSV PCR from blood, CSF and lesions or mucosal sites through the local pathway, and institute contact or public-health measures when indicated.

Synopsis

Recognise congenital infection patterns, test within pathogen-specific diagnostic windows, deliver time-critical HIV and hepatitis B prophylaxis, treat neonatal HSV and syphilis promptly, and coordinate maternal, infant and public-health follow-up.

Congenital infection crosses the placenta; perinatal infection is acquired around delivery. Timing determines phenotype, tests and prevention.
Common patterns overlap: growth restriction, microcephaly, petechiae or blueberry-muffin lesions, jaundice, hepatosplenomegaly, eye disease, intracranial abnormality and hearing loss.
Do not order an indiscriminate TORCH screen. Use maternal history, examination and organ pattern to select pathogen-specific PCR, serology, culture and imaging.

Key red flags

Vesicles, keratoconjunctivitis, seizures, lethargy, hepatitis, coagulopathy or sepsis in the first weeks raises neonatal HSV even without known maternal lesions.

Investigation priorities

First-line: pathogen-specific maternal and infant testingFirst stepFirst line

Confirm exposure and diagnose infection within the relevant biological window.

Management branches

At deliveryDeliver planned prophylaxis

Maternal HIV or hepatitis B is known or discovered around birth.

Alert neonatal infection and pharmacy before delivery where possible and verify maternal results and risk category.
Start HIV prophylaxis as soon as possible, ideally within 4 hours, using the BHIVA gestation- and weight-based regimen.

Key medicines

Neonatal HIV post-exposure prophylaxisStart as soon as possible and no later than 4 hours. BHIVA recommends zidovudine monotherapy for 2 weeks in a low-risk infant. Standard high-risk combination prophylaxis is zidovudine plus lamivudine for 4 weeks with nevirapine for 2 weeks. Select every dose and interval from current BHIVA Appendix 4 using gestation, weight, maternal resistance and feeding plan.

Monovalent hepatitis B vaccine and hepatitis B immunoglobulinGive monovalent hepatitis B vaccine intramuscularly within 24 hours of birth. When UKHSA high-risk criteria apply, also give HBIG 200 IU intramuscularly within 24 hours at a separate injection site, then complete the current selective immunisation schedule.

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Sources and review status6 sources · checked 27 Aug 2026 · clinical review pending

Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

BHIVA pregnancy guidelines 2025Current UK maternal management, newborn prophylaxis, testing and infant-feeding recommendations including dose appendix.
UKHSA hepatitis B antenatal and selective neonatal pathwayCurrent birth vaccine, high-risk HBIG criteria, revised dose schedule and completion testing.
BASHH genital herpes in pregnancy and neonates 2024UK peripartum prevention and neonatal HSV investigation and aciclovir management.
BASHH syphilis in pregnancy 2024Maternal adequacy criteria and infant assessment and treatment pathways.
NHS GGC congenital and postnatal CMV guidelineExplicitly regional UK diagnostic window, assessment, antiviral and monitoring pathway where no single national CMV guideline exists.
European congenital CMV consensus 2024International consensus supporting diagnostic timing and antiviral regimens, labelled because UK national guidance is limited.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom