Maternal Causes Of Infection Woods

MATERNAL CAUSES OF NEONATAL INFECTIONS Professor David Woods Neonatal Medicine Department University of Cape Town South Africa

• Chronic transplacental infections: – – – –

Viruses: HIV, rubella, CMV Spirochaetal: syphilis Protozoal: Toxoplasmosis Rarely bacterial: TB

• Acute ascending transcervical bacterial infection • Contamination in the birth canal: – – – –

Neisseria gonorrhoeae (Gonococcus) Chlamydia trachomatis Group B Streptococcus Herpes simplex

Human Immunodeficiency virus (HIV) • Risk of mother to child transmission: – Transplacental 5% – Labour and vaginal delivery 15% – Mixed breast feeding 15%

• Increased risk with acute infection or AIDS • Transmission <5% with correct management

Rubella • Preventable with routine immunisation • Risk of congenital malformations with first trimester infection • Chronic fetal infection alone with second trimester infection

• Neuronal deafness 60% • Congenital heart disease 50% • Microphthalmia with cataracts 40% • IUGR with hepatosplenomegaly • Microcephaly with mental retardation • Thrombocytopenia • Blue berry muffin rash

Congenital syphilis • May be asymptomatic at birth • Congenital syphilis syndrome • Screen all pregnant women • Benzathine penicillin • Treat all at risk infants with benzathine penicillin • Treat all affected infants with procaine or benzyl penicillin

Neonatal conjunctivitis • Gonococcus or Chlamydia • Usually no history or signs of maternal infection • Prophylaxis with chloromycetin or erythromycin • Presents with mild to severe conjunctivitis – Mild: sticky eye only – Moderate: purulent discharge – Severe: swollen eyelids

• Diagnosis: Gram stain helpful • Treatment depends on severity

• Mild conjunctivitis: clean eye with warm water or saline and antibiotic ointment • Moderate conjunctivitis: local antibiotic eyedrops • Severe conjunctivitis: – Irrigate eye – Parenteral antibiotics – Urgent referral

Group B Streptococcus • Community risk • Role of routine screening • Risk factors: – Previous affected infant – Preterm labour – Prelabour rupture of the membranes – Prolonger rupture of the membranes

• Choice of antibiotic

Herpes simplex • • • • • • • •

Primary vulvovaginitis greatest risk Secondary herpes much lower risk Presentation in mother Diagnosis Role of elective caesarean section Prophylactic acyclovir Presentation in the newborn infant Complications and treatment

HIV infection • • • •

Counsel and screen all pregnant women CD4 count for all HIV positive women Antiretroviral treatment if CD4 below 250 Dual prophylaxis if CD4 above 250: – – – –

AZT from 28 weeks Neverapine in labour Nevirapine to infant AZT to infant for 7 days

• Feeding options • PCR at 6 weeks • Manage mother and infant