3: Neonatology - Talipes Equinovarus and Congenital Infections Flashcards
What is talipes equinovarus also known as
Clubfoot
What gender is talipes equinovarus more common
Males (2:1)
How can the causes of talipes equinovarus be divided
- Idiopathic (primary)
- Secondary
What % of club foot is secondary
20
What are 5 secondary causes of clubfoot
- Spina bifida
- DDH
- Oligohydramnios
- Edward’s
- Cerebral Palsy
What % of talipes equniovarus is bilateral
50
How does the foot appear in clubfoot
- Inverted
- Adducted
- Equinus (plantar flexed)
Define vertical talus
Rare deformity where the foot appears ‘rocker-bottom’ shape
What condition is vertical talus associated with
Edward’s
What causes positional talipes
Uterine compression
Explain how positional talipes appear
- Foot is normal size
- Mild deformity
- Foot can be passively positioned to normal shape
How does the foot appear in talipes calcenovalgus
Foot appears dorsiflexed and everted
What is talipes calcenovalgus associated with
DDH
Explain prognosis of talipes calcanevalgus
Self-resolving
When is talipes equinovarus identified
NIPE
What is used to correct talipes equinovarus
Ponsetti method
What is the poinsetti method
The foot is manipulated and placed in a long-leg plaster cast
What will 85% of people with talipes equinovarus require
Achilles tenotomy
How is child managed long-term with talipes equinovarus
Night-bracing until 4-years
What are congenital infections
Infections that are passed from mother to foetus usually trans-placentally or during delivery
What are the TORCH infections
Toxoplasmosis Other Rubella Cytomegalovirus HSV
What 4 infections are included in ‘other’
- Parvovirus
-
What is the most-common congenital infection in the UK
CMV
Where is toxoplasmosis gondii aquired from
- Undercooked meats
- Handling cat faeces
What % of foetuses are infected with toxoplasmosis if mother is
40
What % of foetuses infected with toxoplasmosis are symptomatic
10
What is the classical triad of congenital toxoplasmosis (HIC)
Hydrocephalus
Intracranial lesions presenting as ring-enhancing lesions on MRI
Chorioretinitis
What is used to confirm foetal infection with toxoplasmosis
Amniocentesis
What are two conservative measures to avoid toxoplasmosis
- Do not handle cat faeces
- Avoid undercooked meats
What can be given to mother’s infected with toxoplasmosis to prevent foetal transmission
Spiramycin
Spiramycin does NOT treat foetal infection
How is toxoplasmosis treated
Pyrimethamine and sulfadiazine for 6W
What organism causes syphilis
Treponema pallidum pallidum
How is syphilis transmitted
Transmitted to mother sexually and then vertically to foetus
When does risk of vertical transmission increase with syphilis
Risk of vertical transmission increases with gestation
What is early congenital syphilis
Onset syphilis before 2-years
How does early congenital syphilis present
- Hepatosplenomegaly
- Jaundice
- Painless lymphadenopathy
- Osteodystrophy
What is late congenital syphills
Onset syphilis after 2-years
How does late congenital syphilis present
Hutchinson’s triad
What is hutchinson’s triad (HIS)
- Hutchinson’s teeth
- Interstitial keratitis
- SNHL
What are other features of late congenital syphillis, aside from hutchinson’s triad
- Saddle nose
- Mulberry molars
- Saber shins
What is used to treat syphilis
Penicillin G
What is prognosis of in-utero syphilis
40% still-birth
What is chickenpox
Primary infections tih VZV
What is shingles
Re-activation of VZV from DRG
What is the risk of VZV in pregnancy
Foetal varicella syndrome
What is risk of VZV infection in pregnancy to mother
Pneumonitis
When is the risk of foetal varicella syndrome highest
If transmitted before 20W
When are NO cases of VZV transmission seen
Beyond 28W
What are the symptoms of foetal varicella syndrome
- Hypoplastic limbs
- Hypertrophic scars
- Seizures
- Hydrocephalus
- Cortical atrophy
What is neonatal varicella virus
When mother is infected 5d prior to delivery to 2d afterwards she can transmit during vaginal delivery
What is the risk of neonatal varicella
High mortality
What is the prognosis of neonatal varicella
High mortality
How can foetal varicella be diagnosed
PCR of amniotic fluid
If suspect mother has VZV what should you do
Test for antibodies
If not immune, what do you give to the mother
IVIg VZV
When is VZV IVIg effective
If given in 10d
What time frame should oral acyclovir be given
24h of rash-onset
When does parvovirus B19 affect infants if transmitted
Before 20W
What does parvovirus B19 cause if vertically transmitted
Severe anaemia
Foetal hydros
What is foetal hydrops
Collection fluid in two or more fluid compartments
How is parvovirus B19 examined for
Amniotic fluid PCR
How is in-utero parvovirus B19 infection managed
Foetal blood transfusion
What is listeriosis
Infection listeria monocytogenes
How can listeriosis be transmitted
Vertically or during delivery
How can listeriosis be transmitted
- Unpasteurised milk: soft-cheese
- Processed vegetables eg. processed salads
What does early-onset listeriosis cause
- Systemic infection characterised by disseminated abscesses
What does late transmission of listeriosis cause
Meningitis
What does listeriosis cause if transmitted
Pre-mature birth
Spontaneous abortion
What is rubella
Infection togavirus
Why is congenital rubella rare
MMR vaccine
When is risk of vertically transmitting rubella highest
Before 20W
When is there no risk of vertically transmitting rubella
After 28W
How can symptoms of congenital rubella infection be remembered
3C’s
What are the 3C’s of congenital rubella infection
Cataract
Cardiac anomalies: PDA and Pulmonary stenosis
Cochlear defect: bilateral SNHL
What cardiac defects are present in congenital rubella
PDA and pulmonary stenosis
What are early features of congenital rubella
- Jaundice
- hepatosplenomegaly
- thrombocytopenia
- haemolytic anaemia
- Salt and pepper chorioretinitis
- Meningitis
- Pneumonia
What are late defects of congenital rubella syndrome
Microcephaly
Cerebral palsy
If rubella infection prior to 16W, what is the managed
Termination
If rubella infection after 16W, what is the managed
Re-assurance
What is the most-common congenital infection
CMV
How can CMV be transmitted
Vertical
Delivery
Breast feeding
What is the chance a foetus will be infected if mother has CMV
40%
What are 3 features of foetal CMV infection
- IUGR
- oligohydramnios or polyhydramnios
- US: hyperechogenic bowel, hydrops foetal is
What are long-term features of CMV infection
SNHL Chorioretinitis Blueberry muffin rash SGA Seizures
What skin features are present in CMV
Blueberry muffin rash
What may be seen on CNS imaging in congenital CMV
Periventricular calcifications
Explain transmission of HSV2 from mother to foetus
- Rare to have trans-placental
- Transmitted during delivery
If intra-uterine how may foetus present
- Pre-mature
- Low birth weight
- Microcephaly
If post-natal how may foetus present
- Skin lesions
- Keratoconjunctivitis
- Meningoencephalitis
When are women with HSV2 advised to have a C-section
If primary infection following 28W gestation
If recurrent attack what is risk of transmission
Rare
What is given to treat neonate of HSV
Acyclovir
