8/14/2019 Maternal Causes of Infection Woods

1/24

MATERNAL CAUSES OFNEONATAL INFECTIONS

Professor David Woods

Neonatal Medicine Department

University of Cape Town

South Africa

8/14/2019 Maternal Causes of Infection Woods

2/24

8/14/2019 Maternal Causes of Infection Woods

3/24

8/14/2019 Maternal Causes of Infection Woods

4/24

8/14/2019 Maternal Causes of Infection Woods

5/24

Chronic transplacental infections:

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

Acute ascending transcervical bacterialinfection

Contamination in the birth canal:

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

8/14/2019 Maternal Causes of Infection Woods

6/24

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

8/14/2019 Maternal Causes of Infection Woods

7/24

Rubella

Preventable with routine immunisation

Risk of congenital malformations with first trimesterinfection

Chronic fetal infection alone with second trimester

infection

8/14/2019 Maternal Causes of Infection Woods

8/24

Neuronal deafness 60%

Congenital heart disease 50%

Microphthalmia with cataracts 40%

IUGR with hepatosplenomegaly

Microcephaly with mental retardation

Thrombocytopenia

Blue berry muffin rash

8/14/2019 Maternal Causes of Infection Woods

9/24

8/14/2019 Maternal Causes of Infection Woods

10/24

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 orbenzyl penicillin

8/14/2019 Maternal Causes of Infection Woods

11/24

8/14/2019 Maternal Causes of Infection Woods

12/24

8/14/2019 Maternal Causes of Infection Woods

13/24

8/14/2019 Maternal Causes of Infection Woods

14/24

8/14/2019 Maternal Causes of Infection Woods

15/24

8/14/2019 Maternal Causes of Infection Woods

16/24

8/14/2019 Maternal Causes of Infection Woods

17/24

Neonatal conjunctivitis

Gonococcus or Chlamydia Usually no history or signs of maternalinfection

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

8/14/2019 Maternal Causes of Infection Woods

18/24

8/14/2019 Maternal Causes of Infection Woods

19/24

8/14/2019 Maternal Causes of Infection Woods

20/24

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

8/14/2019 Maternal Causes of Infection Woods

21/24

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

8/14/2019 Maternal Causes of Infection Woods

22/24

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

8/14/2019 Maternal Causes of Infection Woods

23/24

8/14/2019 Maternal Causes of Infection Woods

24/24

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