Neonatal infections. Joanna Seliga-Siwecka

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1 Neonatal infections Joanna Seliga-Siwecka

2 Neonatal infections Early onset sepsis Late onset sepsis TORCH

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7 Early onset sepsis (EOS) Blood or cerebral fluid culture-proven infection at fewer than 7 days of age 1 to 2 cases per 1000 live births, 10 fold higher in VLBW infants

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9 Symptoms of neonatal infection Respiratory distress Letargy Hypo-/hyperglycaemia Tempreture instability Acidosis Feeding intolerance seizures apnea Cyanosis Hypoperfusion, shock Jaundice sick baby

10 Risk factors Premature ruputure of membranes Chorioamnionitis GBS carriage UTI prematurity

11 Late onset sepsis (LOS) Blood or cerebral fluid culture-proven infection at more than 7 days of age Blood or cerebral fluid culture-proven infection at more than 72 hours of age Difficult to diagnose

12 Congenital infections TORCH T-toxoplasmosis O-other R-rubella C-cytomegaly H-herpes

13 Human cytomegaly virus (HCMV) Acquired in infancy (saliva sharing) 90 % in developing countries 60% in developed countries more widespread cause of of birth defects than Trisomy 21, and FAS (Fetal Alcohol Syndrome) HCMV is the most common cause of nonhereditary sensoneural hearing loss in children Main source of infection for pregnant women; young child, and sexual partners

14 Clinical manifestation Hepatosplenomegaly Conjugated hyperbilirubenaemia Thrombocytopenia with petechiae/purpura (blueberry muffin) Small for gestation age Microcephaly, intracranial calcifications chorioretinitis

15 One-day-old term infant who exhibits cholestatic jaundice and blueberry muffin spots consistent with extramedullary (dermal) hematopoiesis after congenital human cytomegalovirus infection. Tian C et al. Neoreviews 2010;11:e436-e by American Academy of Pediatrics

16 Newborn who has microcephaly associated with congenital human cytomegalovirus infection. Tian C et al. Neoreviews 2010;11:e436-e by American Academy of Pediatrics

17 A. Tian C et al. Neoreviews 2010;11:e436-e by American Academy of Pediatrics

18 Diagnosis and treatment of congenital HCMV Combination of antibody avidity (HCMV IgG) and anti-hcmv IgM Gancyclovir

19 Congenital toxoplasmosis Most common parasitic infection 0.1 to 1 in 1000 live births Domestic cat is the primary host of T. gondii Kittens are more likely to excrete than adult animals

20 Congenital toxoplasmosis

21 Congenital toxoplasmosis Most women are symptom free 15 % report acute flulike illness with lymphadenopathy Incidence of transmission is 2% at 10 GA, and 80% at close to term The later the infection occurs, the less severe the disease

22 Clinical manifestation 70-90% asymptomatic at birth 80% will develop learning or visual disabilities later in life Some present with a systemic form of disease (maculopapular rash, lymphadenopathy, hepatosplenomegaly, thrombocytopenia, jaundice) Predominate CNS manifestation meningoencephalitis, intracranial calcifications, hydrocephaly, chorioretinitis, seizure disorder, deafness

23 Diagnosis and treatment Antenatal: PCR for detecting parasite DNA in amniotic fluid or fetal blood Postnatal Cord or infant blood IgG antibodies Treatment: spiramycin, cotrimoxazolee, folinic acid

24 Congenital Rubella Syndrome In the US before licensure of vaccine 1969 the 57,686 case of congenital rubella syndrome Now fewer than 10 cases Congenital defects in 75% if infection occurs during first 8 WGA 50% 9-12 WGA 20% WGA 0-10% > 20 WGA

25 Clinical manifestations Adenopathy Radiolucencies of long bones Encephalitis Cardiac defects Cataracts Microphtalmia IUGR Hepatosplenomegaly Thrombocytopenia Purpura Newborns may be asymptomatic at birth, but develop a sequelae during the first year of life

26 Diagnosis Typical clinical infection in the mother (1-5 prodromal low grade fever, headache, malaise, mild coryza and conjuctivitis, arthralgia or arthritis Fetal or postnatal testing for rubella specificigm (pharygeal secretions, eye, throat, CSF, stool and urine)

27 Prevention and Treatment Vaccination MMR? No specific treatment

28 Herpes Simplex Virus Usually typ 2 primary type of HSV associated with genital infection Transmission rate for intrapartum infection is 88-93%, which is much higher than for other routes (antenatal, postpartum)

29 Clinical manifestations 1-3 weeks post delivery Localized disease: vesicles or zoster like eruptions on skin, eyes or mouth. 70% progress to a disseminated disease: poor feeding, fever, lethargy, apnea, convulsions, respiratory distress, hepatomegaly, jaundice, DIC, meningitis.

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33 Treatment Skin-eye mouth disease: iv acyclovir 20 mg/kg

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