Background Neonatal herpes infection can have devastating outcomes for otherwise healthy babies. In the UK, the stated incidence is low at 1.65 per 100 000 live births, which is in contrast with an incidence of 33 per 100 000 in the USA. We aimed to discover the current incidence of neonatal herpes infection in our tertiary service, determine the timing of presentations, and to consider which presenting features could be used for early recognition and prognostication.

Methods All cases of neonatal herpes infection occurring in the last 8 years were reviewed, and those cases from an agreed population were used to calculate an incidence. The statistical associations between clinical features and death were examined.

Findings There were 57 291 live births between 2006 and 2012. Nineteen cases were identified including 10 from the study population (17.5/100 000 live births). There were nine deaths, all presenting later than 6 days of age. Independent predictors of death were haemodynamic instability, coagulopathy, bleeding and central nervous system features at presentation. All presentations occurred within 2 weeks of birth and were varied and often non-specific.

Interpretation Our incidence rate of 17.5 per 100 000 live births represents a significant increase and is much more in line with the higher incidence rates seen in the USA. The range of presentations shows the non-specific nature of this disease. We advocate a heightened awareness of this treatable disease in the UK, and encourage adoption of modern rapid diagnostic techniques and the wider inclusion of Aciclovir in treatment regimens for neonatal sepsis.