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I am working with a mom of a 3.5 week old baby. Baby was born vaginally without difficulty but was posterior. Baby has great tongue mobility but some asymmetry in movement. I have suggested CST to address structural tension.

Baby had excessive weight loss and was very sleepy after birth. Mom saw several LCs who suggested pumping and bottle-feeding after breastfeeding if Mom felt the feed went poorly. Baby's latch was not consistent and weight gain was still slow on this plan (about 1/2oz/day). Baby also had some formula supplementation due to difficulty with milk expression.

Mom had perineal pain and an open episiotomy incision @ 6days postpartum and saw OB @11days postpartum. OB recommended sitz baths and took a culture of the infection. Mom was informed of HSV1 infection on day 18 and began taking Valtrex on day 19. Mom has never had any sign of HSV1 previously, so this is a presumptive primary infection. 

Mom spoke to me about a consult on day 19 but did not mention the HSV1. I was not able to see her right away and she followed my suggestions for more frequent milk expression, bottle-feeding expressed milk, and breastfeeding for dessert. During this time, Baby has gained 6 ounces in 5 days so weight and milk supply are now on track. Even with the recent good weight gain, Mom reports that Baby has still been very sleepy and latching was inconsistent.

At my visit today, some positioning adjustments helped Baby to latch better and he transferred 100ml in less than 25 minutes. Baby had very normal sucking dynamics; no clicking or coughing and good coordination of sucking, swallowing, and breathing.

My question is about the HSV1 infection. Baby's PCP does not know about the infection. Mom will be contacting PCP tomorrow and I will also contact her. What is the protocol for assessing/monitoring Baby for possible HSV1 infection when the mom first had signs of a primary outbreak 6 days postpartum? I know HSV1 infection of a newborn is very serious but I do not know about the likelihood of transmission if the symptoms started after birth. The mom's OB and the baby's PCP have not communicated about this and Mom not informed that HSV1 infection of the newborn is serious. From what I have read, the signs of neonatal HSV infection are not always easy to spot and they include sleepiness and feeding difficulties.

Does anyone have experience with this set of circumstances?

Laura Spitzfaden, LLLL, IBCLC

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