-
how do you confirm congenital rubella infection?
serology as clinical diagnosis unreliable
-
up to how many weeks GA is rubella most dangerous for fetes? what happens?
- 8-10 weeks
- hepatosplenomegaly, growth retardation
- heart: PDA, PS
- sensorineural hearing loss
- eyes: glaucoma, cataract, retinopathy
-
what is the problem with rubella infection at 13-16 weeks?
sensorineural deafness
-
what has prevented rubella?
MMR
-
what is the most common congenital infection?
CMV
-
out of all pregnant women who become infected with CMV, what % of infants become infected?
40%
-
when is maternal CMV important?
if it is their first time CMV infection, otherwise if woman is already immune - unlikely to damage fetes
-
what % of CMV infected infants are normal at birth?
90%
-
what happens to the other 10% of not normal infants?
- 5% get CMV inclusion disease
- 5% problems later in life - sensorineural hearing loss
-
what are features of CMV inclusion?
- hepatosplenomegaly
- petechiae
- microcephaly
- SGA
- choroidoretinitis
- seizires
- pneumonitis
- thrombocytopenia
-
how can you get toxoplasmosis?
- raw or undercooked meat - tissue cysts
- contaminated vegetables
- contact with faeces of recently infected cats
-
what are the features of congenital toxoplasmosis?
- choroidoretinitis
- cerebral calcification
- hydrocephalus
-
what determines damage to fetus in toxoplasmosis?
- 1st trimester - 25% infection, 75% damage
- 2nd trim - 50% infection, 55% damage
- 3rd trim - 65% infection, <5% damage
-
if there is an asymptomatic infant with toxoplasmosis, are they at risk of anything in future?
yes choroidoretinitis in adulthood
-
what blood test do you do to see if there is maternal infection with toxo?
- not IgM as it can stay positive for 3 yrs!!
- need combo of IgG, IgM IgA and avidity
-
what tests to do for fettle infection?
- imaging
- PCR on amniotic fluid
- post natal serology IgG until 12 months
-
what are treatment options during pregnancy if toxoplasmosis is found?
- termination
- sulphadiazine/pyrimethamine/folinic acid alternating with spiramycin
-
what is Rx for neonate with congenital toxoplasmosis?
sulphadiazine/pyrimethamine/folinic acid
-
how can congenital toxoplasmosis be prevented?
- avoid undercooked meats and undercooked vegetables
- avoid cat litter
-
when is the risk of fettle varicella syndrome highest?
first 20 weeks of pregnancy
-
what are features of F varicella synd?
- Limb hypoplasia
- Eye defect
- Neuro
- Skin scarring in a dermatomal distribution
-
what other stage in pregnancy is it dangerous for the FETUS if mother is exposed to varicella?
- week before and 2 days after birth
- viral load is high
- fetes is unprotected - doesn't have maternal Abs
- high risk of disseminated chickenpox as immune system is weak
-
what is given to exposed susceptible women? up to when can you give this?
VZIg within 10 days of exposure
-
if pregnant woman actually gets chickenpox, what is given?
aciclovir
-
what is given to neonate born in the high risk period?
- VZIg
- aciclovir prophylaxis
-
what is the risk of maternal shingles in pregnancy to the fetes?
- no risk
- unless mother immunosuppressed
- or shingels disseminated
-
what is congenital syphilis caused by?
treponema pallidum
-
how common is congenital syphilis?
very rare
-
how is syphilis detected in pregnant woman?
antenatal screening
-
what can prevent transmission of syphilis?
- treatment during pregnancy
- im procaine penicillin for 10 days
- or 1 dose benzathine penicillin
-
what are early signs of congenital syphilis? up to what age?
- up to 2 yrs
- skin rashes
- syphilitic snuffles
- osteochondritis, periostitis
- hepatosplenomeagly
- GN
- thrombocytopenia
-
what are late manifestations of congenital syphilis?
- cluttons joints
- gummatous involvement
- hutchinson's teeth
- interstitial keratitis
-
what is Rx of infected neonate with syphilis?
iv or im penicillin for 10 days
-
what does early onset GBS infection mean - hours?
48 hours of birth
-
what is the manifestation of early onset GBS?
septicaemia
-
how does neonate get GBS?
passage through colonised birth canal
-
what are RF for developing early GBS disease?
- prematurity
- prolonged ROM
- maternal pyrexia
- previous infected baby
- documented GBS during pregnancy
-
what is the outcome of early GBS disease?
high mortality
-
what is definition of late onset GBS?
> 1 week after birth
-
what is the clinical manifestation of late GBS?
meningitis
-
what is mortality of late GBS cf to early GBS?
- lower mortality in late
- 5%
-
what are the main complications of late GBS?
longterm neurological sequelae
-
how is GBS diagnosed?
culture
-
how is GBS prevented?
- mother with risk factors needs intrapartum antibiotics
- monitor baby for sepsis
- infection control
-
what is Rx of GBS infection?
iv penicillin and gentamicin
-
what can listeria cause in baby?
meningitis or sepsis
-
what time frame does listeria infection happen in baby?
within 2 weeks of birth
-
what is Rx of listeria infection?
- iv amoxicillin and gentamicin
- 2-3 weeks
-
how does mum get listeria?
-
what is ophthalmia neonatorum?
infectious neonatal conjunctivitis
-
what are 4 main causes of ophthalmia neonatorum?
- gonorrhoea
- chlamydia trachomatis
- staph aureus
- strep pneumo
-
how many days after birth does gonococal conjunct present?
5 days
-
what is feature and Ix and Rx of gonoc conjunct?
- purulent discharge
- eye swab - M&C
- Rx: benpen or cefotaxime
-
how many days after birth does chlamydial conjunct present?
6-21 days
-
what is features, Ix and Rx of chlamydial conjunct?
- mucopurulent discharge
- NAAT on eye swab
- Rx: topical tetracycline and systemic erythromycin
-
apart from conjunctivitis from chlamydia, what else can neonate get?
- pneumonitis
- staccato cough, dyspnoea
- 3 weeks - 3 months
- Rx: erythromycin 10-14 days
|
|
