PERINATAL INFECTIONS

MIHAI CRAIU MD PhD LECTURER IN PAEDIATRICS

PERINATAL INFECTIONS
CONGENITAL INFECTIONS OTHER MATERNAL INFECTIONS DURING PREGNANCY NEONATAL INFECTIONS
SUPERFICIAL INFECTIONS SYSTEMIC INFECTIONS

PERINATAL INFECTIONS
CONGENITAL INFECTIONS OTHER MATERNAL INFECTIONS DURING PREGNANCY NEONATAL INFECTIONS
SUPERFICIAL INFECTIONS SYSTEMIC INFECTIONS

 CONGENITAL INFECTIONS This is a heterogeneous group of diseases of the pregnant woman that can affect the fetus with long-term sequelae. Acronim for this group is TORCH
Toxoplasmosis (T) Other (syphilis, parvovirus, etc) (O) Rubella (R) CMV (C) Herpes simplex (H)

PERINATAL INFECTIONS

PERINATAL INFECTIONS
CONGENITAL TOXOPLASMOSIS Most infants are asymptomatic Without treatment children can face longterm severe handicap (CNS) Prognostic can be improved by early detection & treatment of pregnant woman

PERINATAL INFECTIONS
CONGENITAL TOXO. Clinical features: Hydrocephalus OR Microcephaly Chorioretinitis Cerebral calcifications

CONGENITAL RUBELLA (GREGG SYNDROME) Now exceptionally rare due to universal MMR vaccination in developed countries (1-2/100000 births) Clinical features
Cataracts Chorioretinitis Microcephaly CHD Severe mental retardation

PERINATAL INFECTIONS

CYTOMEGALOVIRUS INFECTION Now CMV is the most frequent congenital infection (1-2/100 births) 90% of infants are asymptomatic Clinical features

PERINATAL INFECTIONS

SGA Chorioretinitis Microcephaly with cerebral calcifications Hepatosplenomegaly & jaundice Anemia & trombocytopenia Sequelae: mental retardation & deafness in 15%

HERPES VIRUS INFECTION HSV-2 is genital herpes in women produces infection in fetus Usually transmitted intrapartum,with a 50% risk of transmission during vaginal delivery in women with active disease Lower risk in C-section delivery

PERINATAL INFECTIONS

HERPES VIRUS INFECTION Clinical features

PERINATAL INFECTIONS

May have a 2 weeks postnatal incubation Initially skin vesicles; untreated 70% generalized Often fulminant and fatal Localized disease : pneumonitis or encephalitis Generalized disease involves liver, adrenals, brain lungs Jaundice, Hepatosplenomegaly, DIC, Anemia, Trombocytopenia

HERPES VIRUS INFECTION Treatment

PERINATAL INFECTIONS

Acyclovir iv In asymptomatic newborn children delivered vaginally by mother with active disease send samples from conjunctiva and nasopharinx If PCR positive start treatment.

PARVOVIRUS B19 INFECTION Infection in rare in pregnant woman 3% Exceptionally the fetus is infected 2% of positive mothers Clinical signs
Severe anemia. Hydrops fetalis due to anemia and cardiac failure Miocarditis

PERINATAL INFECTIONS

PERINATAL INFECTIONS
CONGENITAL INFECTIONS OTHER MATERNAL INFECTIONS DURING PREGNANCY NEONATAL INFECTIONS
SUPERFICIAL INFECTIONS SYSTEMIC INFECTIONS

PERINATAL INFECTIONS

HUMAN IMMUNODEFICIENCY VIRUS Perinatal transmission is the major route involved in children (vertical transmission) Transmission rate is ~20% 2/3 of cases are infected during delivery The rest are prenatally or few months after Prenatal treatment of mother & C-section + antivirals in baby have some protective value

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HEPATITIS B Perinatal transmission is the major route involved in children (vertical transmission) Major risk is in women with
Positive antigen HBs And positive HBe-antigen and negative HBe-antibodies

PERINATAL INFECTIONS
HEPATITIS B These children should be treated asap
200 UI im (NOT iv) specific anti-HB immunoglobulin, not later than 48h HB vaccine first dose should be done 0.5 ml im in a different place, at the same time Next doses are
2nd at one month after first one 3rd at 4 monts after the second

PERINATAL INFECTIONS
CONGENITAL INFECTIONS OTHER MATERNAL INFECTIONS DURING PREGNANCY NEONATAL INFECTIONS
SUPERFICIAL INFECTIONS SYSTEMIC INFECTIONS

PERINATAL INFECTIONS
SUPERFICIAL INFECTIONS Staph aureus pustulosis, Breast abscess Paronichia Rare complication: toxic epidermal necrolysis

OMPHALITIS
The umbilicus should be cleaned daily with clorhexidine The catheterized umbilicus should be treated daily with povidone-iodine If skin around umbilicus becomes inflamed than do a blood culture and start iv antib

PERINATAL INFECTIONS
CONGENITAL INFECTIONS OTHER MATERNAL INFECTIONS DURING PREGNANCY NEONATAL INFECTIONS
SUPERFICIAL INFECTIONS SYSTEMIC INFECTIONS

PERINATAL INFECTIONS
Increased risk of early-onset sepsis (<48h from delivery) is present in:
Prolonged rupture of membranes (>24h) Prolonged labour Multiple obstetric procedures Preterm labour Fetal distress Maternal pyrexia/infection, especially UTI Foul-smelling amniotic fluid

PERINATAL INFECTIONS
The commonest organisms involved in early-onset sepsis are:
E coli Group B Streptococcus Listeria monocytogenes and less frequent Haemophillus influenzae Neisseria gonrrhoeae Herpes virus Candida albicans

PERINATAL INFECTIONS
Increased risk of late-onset sepsis (>72h from delivery) is present in:
Meconium aspiration Female > male newborn children Congenital malformations (urogenital, spina bifida, gastrointestinal tract) Preterm labour Iv lines (umbilical catheters, arterial lines) Endotracheal tubes Infusions and parenteral nutrition

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The commonest organisms involved in late-onset sepsis are:
Staphylococcus aureus and epidermidis E coli Pseudomonas aeruginosa Klebsiella spp Proteus spp Streptococci Candida albicans