A retrospective review of herpes simplex virus (HSV) infections within the first 30 days after birth in infants born at <37 weeks was conducted at Johns Hopkins University School of Medicine, Baltimore, MD. Ten preterm singletons and a set of twins were infected with HSV-2 and presented with either disseminated disease (n=9) or encephalitis (n=3). All infants with disseminated disease died, whereas the 3 with encephalitis survived. All developed respiratory distress, and viral cultures were positive. Ten were treated with acyclovir within 48 hours of onset; 2 of 3 treated with high-dose acyclovir (60 mg/kg/day) survived. 
COMMENT. HSV infections in preterm infants present with respiratory distress and a high incidence of disseminated disease. In this population, response to acyclovir is poor and mortality high. The AAP Red Book (2006;p365) states that most neonates treated for HHV encephalitis survive, but most suffer substantial neurologic sequelae. Approx 25% of neonates with disseminated disease die despite antiviral therapy.