Perinatal Infections

Question 1

How old is a neonate?

Answer 1

First month (4 weeks) of life

Question 2

2 ways congenital (in utero) infections can happen

Answer 2

Transplancental

Ascending from the cervix

Question 3

When does
1. Innate
2. Adaptive
immune system develop?

Answer 3

1. Develops by 3rd trimester (but cells still mature and function weeks after birth)
2. Still developing until up to 2 years old

Question 4

What antibody is passed across the placenta?

Answer 4

IgG

So an infant’s serology is the same as mum’s! Not reflective of if they have an infection or not

Question 5

Why is the infection rate for premature babies so much higher?

Answer 5

Immune system is immature
Passive transfer of maternal antibodies is not complete
Skin barrier is compromised
Multiple lines (IV, ET tube, etc)

Question 6

4 routine serologies to check in the 1st trimester

Answer 6

Syphilis
HIV
HepB
Rubella

Question 7

Symptoms of severe cases of congenital CMV

Answer 7

Intrauterine growth restriction
Microcephaly
Chorioretinitis
Petechial rash
Hepatosplenomegaly

Question 8

Long term sequelae of congenital CMV

Answer 8

Sensorineural hearing loss (progressive*)

Cognitive and motor delay in severe cases

Question 9

Where are you going to see calcifications on a head ultrasound for

1. CMV
2. Toxoplasmosis

Answer 9

1. Periventricular

2. Parenchymal

Question 10

What antibiotic do you use to treat CMV?

Answer 10

Ganciclovir

Question 11

When is neonatal serology reliable?

Answer 11

18 months old

Question 12

Signs of congenital syphilis

Answer 12

Rhinitis, snuffles
Maculopapular rash, desquamation
Hepatosplenomegaly
Osteochondritis
Anemia, thrombocytopenia
Teeth abnormalities

Question 13

3 ways HSV presents in the 1st 6 weeks of life

Answer 13

Skin eye mouth disease
HSV encephalitis
Disseminated disease (CNS, pneumonia, liver dysfunction, skin)

Question 14

What is the most common bacterial pathogen causing neonatal sepsis

Answer 14

GBS

E coli is second

Question 15

When should you assume sepsis and meningitis in a neonate

Answer 15

If there is fever and lethargy in a <4 week old

Question 16

4 causes of sepsis and meningitis in a neonate

Answer 16

LEG
Listeria
E coli
GBS
HSV

Question 17

3 causes of meningitis in a 3 month old to adult

Answer 17

Strep pneumo
H flu
N meningitidis

Question 18

Full septic workup

Answer 18

Minimum:
Blood cultures
Lumbar puncture
Urine sample
Empirically: ampicillin, gentamicin, acyclovir