Congenital and Neonatal Infections

Question 1

When is the fetus at the highest risk from toxins, mutagens, and infections?

Answer 1

First trimester

Question 2

For congenital infections, how can the fetus acquire them during gestation? What determines worse severity?

Answer 2

Placenta (maternal blood), fallopian tubes, cervix, amniocentesis;
earlier the mother is infected means more harm to developing organs and acute maternal infection WORSE than reactivation for fetus

Question 3

Mother often has; detect in their serum

Answer 3

no symptoms of infection, so you’ll only see something once INFANT is affected; think about fever, rash, sick children for maternal exposure;
IgM or rising IgG titer

Question 4

Definitive diagnosis of congenital infection:

Answer 4

isolate pathogen from the infant (sample urine, saliva, CSF, nasopharyngeal swabs); something like maternal IgG confounds neonatal serology

Question 5

Signs of congenital toxoplasmosis; lab tests; how to treat? Potential sequelae:

Answer 5

Chorioretinitis, hydrocephalus, intracranial calcifications;
IgM pos in infant is diagnositic (do PCR on infant samples, amniotic fluid, or placenta);
Pyrimethamine, sulfadiazine, folinic acid for 1 year;
think about chorioretinitis that results in vision loss if SUBCLINICAL

Question 6

How does congenital syphilis arise? When do the symptoms appear and how can you diagnose? Treatment?

Answer 6

Crosses placenta and infects fetus (common miscarriage/stillbirth/neonatal death) to beget hepatomeg, rhinitis (snuffles), rash, and LAD;
think most often by FIVE weeks, but usually by 3 months of age;
think VDRL or RPR, along with darkfield or direct fluorescent Ab;
Treat both mother and infant with penicillin!!!

Question 7

Congenital rubella pathogenensis, symptoms, and prevention/treatment:

Answer 7

Path: infects placenta, then fetus;
Symp: hearing loss (most common), microcephaly, PDA, cataracts, also thrombocypoenia purpura (blue baby like CMV);
Prevention: live-attenuated vaccine that is TRIVALENT!!!

Question 8

Risk factors for congenital CMV; worst diagnosis?:

Answer 8

1. No prior infection with CMV
2. Pregnant at YOUNGER age
3. FIRST pregnancy
4. New sex partner during preg
5. A lot of interaction with babies and toddlers
6. Mother unaware she has problems;
   primary infection (much higher virus levels in blood, whereas CMV reactivation rarely crosses placenta) with CMV during early pregnancy

Question 9

Path and Symp of CMV; incidence of congenital CMV; diag?; treat and prevent:

Answer 9

Path: goes slowly through placenta, reaches FETAL blood, then damages developing organs;
think HEARING LOSS, HSM, purpura, microcephaly, chorioretinitis;
about 10000 cases of symp congenital CMV disease in US each year;
PCR on urine or blood; culture virus from urine or saliva
Treat: ganciclovir or valganciclovir (but not good);
Prevent: sanitize yourself around babies

Question 10

Congenital Herpes simplex infections: variables that contribute to severity:

Answer 10

in mother, virus type HSV-2 worse than HSV-1, primary worse than reactivation, visible lesions worse than subclinical reactivation; in child, intrauterine worse than perinatal, disseminated infection worse than encephalitis and skin lesions

Question 11

Most frequent HSV scenario vs. most severe scenario; how to treat and prevention

Answer 11

Frequent: mother with recurrence of HSV-2 at birth, neonate acquires virus at full term;
severe: mom with primary HSV-2 infection during preg, fetus born with DISSEMINATED virus;
Treat: IV acyclovir WELL-TOLERATED for infant;
Prevent: C-section if frequent outbreaks, but also antiviral prophylaxis

Question 12

Congenital Varicella syndrome: treat and prevent?

Answer 12

Treat: acyclovir and derivatives for mom;
Prevent: vaccinate seroneg women who reach childbearing age

Question 13

Parvovirus: symps; treat and prevent?

Answer 13

Symps: think school-age children during winter/spring, and look for febrile illness preceding slapped cheek rash along with maculopapular rash, arthralgia/arthritis;
seroneg pregnant women at risk for fetal death;
treat and prevent: NONE!!!

Question 14

Perinatal infections:

Answer 14

acquired during or shortly after birth;
Think exchange of maternal and fetal blood; also fetal monitors attached to scalp breaking the skin; also vaginal and skin flora colonizing neonate during birth; viruses can be secreted in breastmilk

Question 15

Hep B: prevalence, prevention and treatment

Answer 15

Prev: up to 50% population is seropositive;

Prevent and treat: vaccinate ALL neonates and add HBIG

Question 16

Prevention of perinatal transmission of HIV:

Answer 16

3-part zidovudine regimen: antenatal, intrapartum, and neonatal; also focus on antepartum, intrapartum, and infant antiretroviral prophylaxis in general

Question 17

Group B strep: risk factors, risk reduction, symps

Answer 17

Risk factors: previous baby with GBS disease, GBS in urine, fever during labor, heavy maternal colonization, delivery before 37 wks of gestation, premature or prolonged rupture of membranes; intrapartum antibiotic prophylaxis reduces risk;
EOGBS: look for respiratory (grunt) symptoms, temp instability, shock (pneumonia early: week 1);
LOGBS: Meningitis (bulging fontanel, nuchal rigidity, focal neurologic findings; sepsis);
LLOGBS: sepsis with foci in CNS, soft tissues, bones and joints

Question 18

GBS diag and management:

Answer 18

Diag: culture bacteria from normally sterile site;
Treat: PENICILLIN G with intrapartum antibiotic prophylaxis for mom; might need vanco if any resistance