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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?
what has prevented rubella?
what is the most common congenital infection?
out of all pregnant women who become infected with CMV, what % of infants become infected?
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?
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?
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?
- cerebral calcification
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?
- PCR on amniotic fluid
- post natal serology IgG until 12 months
what are treatment options during pregnancy if toxoplasmosis is found?
- sulphadiazine/pyrimethamine/folinic acid alternating with spiramycin
what is Rx for neonate with congenital toxoplasmosis?
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
- 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?
what is given to neonate born in the high risk period?
- 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?
how common is congenital syphilis?
how is syphilis detected in pregnant woman?
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
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?
how does neonate get GBS?
passage through colonised birth canal
what are RF for developing early GBS disease?
- prolonged ROM
- maternal pyrexia
- previous infected baby
- documented GBS during pregnancy
what is the outcome of early GBS disease?
what is definition of late onset GBS?
> 1 week after birth
what is the clinical manifestation of late GBS?
what is mortality of late GBS cf to early GBS?
- lower mortality in late
what are the main complications of late GBS?
longterm neurological sequelae
how is GBS diagnosed?
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?
- chlamydia trachomatis
- staph aureus
- strep pneumo
how many days after birth does gonococal conjunct present?
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?
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?
- staccato cough, dyspnoea
- 3 weeks - 3 months
- Rx: erythromycin 10-14 days