Neonatal infections

Question 1

EOS

Answer 1

48-72 Hours
high case fatality
fulminant septicaemia illness
vertical transmission - vaginal ascending/ postnatally

Question 2

Organisms and treatment EOS

Answer 2

GBS
Listeria monocytogenes
Staph aureus

Amikacin and Penicillin G

Question 3

LOS

Answer 3

> 72 Hours
nosocomial/ maternal genital tract
identifiable focus - meningitis, sepsis
RF - include duration central catheters, TPN, prematurity, length hospital stay, abdominal surgery for NEC

Question 4

Risk factors for EOS

Answer 4

premature labour < 37 weeks GA 
PROM > 18 hours 
traumatic delivery 
chorioamnionitis 
MSL 
low SES 
colonisation with GBS

Question 5

Organisms and treatment LOS

Answer 5

Enterococcus 
Staph epidermidis 
MRSA 
E coli 
Pseudomonas
Klebsiella 

depends on nursery
vancomycin, carbapenem, anti-fungal

Question 6

Diagnosis of sepsis

Answer 6

blood, urine or CSF culture is Gold standard

Question 7

CMV

Answer 7

maternal primary CMV - 30-40% risk (33) 
IUGR - SGA/LBW 
Chorioretinitis 
Microcephaly 
periVentricular calcifications 
SNHL 
Jaundice - Hepatitis 
Hepatosplenomegaly
BLUEBERRY MUFFIN RASH = extra medullary haematopoiesis 
thrombocytopenia and anaemia = purpura

Question 8

Rubella

Answer 8

primary 80-90% risk in first trimester
rubella does not kill cells - limits their growth and division - IUGR
affects developing foetal heart, brain, eyes, ears liver, spleen, BM
petechiae - thrombocytopenia
BLUEBERRY MUFFIN SYNDROME
hepatosplenomegaly
jaundiced
glaucoma, cataracts SNHL
congenital heart disease - PDA, PS, septal defects
triad - cataracts, cardiac abn, deafness SNHL

vaccine not part of EPI
Amniocentesis after 20w
Cordocentesis after 18-20 weeks
Sonar for heart defects

Question 9

Toxoplasmosis

Answer 9

Classic tetrad

• hydrocephalus
• epilepsy
• cerebral calcifications
• chorioretinitis

Question 10

Varicella

Answer 10

Congenital varicella syndrome 
mom had varicella 5 days before or 2 days after delivery 
skin scarring 
limb hypoplasia 
signs infection 
hepatitis, pneumonia, encephalitis 

1st and 2nd trimester infected
micro/hydrocephaly
disruptions ophthalmic structures
cicatricial skin rash

Question 11

Parvovirus B19

Answer 11

second trimester pregnancy carries highest risk
erythema infectiosum/ slapped cheeks syndrome
IU foetal death
Hydrops fetalis
foetal anaemia
myocarditis
spontaneous abortion

PCR on amniotic fluid after 20w gestation
cordocentesis on cord blood after 22 weeks gestation