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Chapter: Paediatrics: Neonatology

Paediatrics: Transplacental (congenital infection)

Causes • ‘TORCH’ infections. • Herpes zoster. • Parvovirus B19. • Syphilis. • Enterovirus.

Transplacental (congenital infection)

 

Causes

 

•   ‘TORCH’ infections.

 

•   Herpes zoster.

 

•   Parvovirus B19.

 

•   Syphilis.

 

•   Enterovirus.

 

•   HIV; hepatitis B.

 

•   Rarely bacterial, e.g. GBS, Listeria monocytogenes, N. gonorrhoeae.

 

Presentation

 

•   TORCH infection: SGA, jaundice, hepatitis, hepatosplenomegaly, purpura, chorioretinitis, micro-ophthalmos, cerebral calcification, micro/macrocephaly, hydrocephalus.

•   Rubella and CMV: also cause deafness, cataracts, congenital heart disease, osteitis (rubella only).

•   Parvovirus B19: rubella-like rash, aplastic anaemia +/– hydrops.

•   Herpes zoster: cutaneous scarring, limb defects, multiple structural defects.

•   Congenital syphilis: SGA, jaundice, hepatomegaly, rash, rhinitis, bleeding mucous membranes, osteochondritis, meningitis.

•   Bacterial infections present with features that may be non-specific or even result in multi-organ failure. Gonorrhoea causes purulent conjunctivitis (ophthalmia). Listeriosis causes preterm labour and meconium-stained liquor.

 

Investigation

 

Consider:

 

•   Blood culture.

 

•   Pathogen-specific IgM and IgG (paired for Herpes zoster, Toxoplasma).

 

•   Venereal Disease Research Laboratory (test)(VDRL).

 

•   Maternal-specific serology.

 

•   Urine CMV culture.

 

•   Throat swab viral culture.

 

•   CSF culture and latex particle agglutination (GBS).

 

•   Stool viral culture.

 

•   Skin vesicle viral culture and electron microscopy.

 

Treatment

 

•   Most congenital infections have no specific treatment.

 

•   General treatment is supportive and involves careful follow-up to identify sequelae, e.g. deafness and CMV.

 

•   Toxoplasma: spiramycin (4–6wks 100mg/kg/day) alternating with pyrimethamine (3wks 1mg/kg/day) plus sulfadiazine (1yr 50–100mg/kg/ day).

 

•   Syphilis: benzylpenicillin 14 days 30mg/kg 12-hourly IV.

 

•   Symptomatic CMV: consider IV ganciclovir then oral valganciclovir.

 

Prognosis 

Variable and depends on disease severity.

 

 

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Paediatrics: Neonatology


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