CONGENITAL AND ACQUIRED NEONATAL INFECTIONS
DR. ELFADIL EISA IDRIS SULIMAN
Overview and Definitions
Congenital infection refers to an infection that is transmitted from a mother to her child during pregnancy or during delivery. These infections can lead to range of health problems in the newborn from mild to severe and even be life threatening.
Scope of Pathogens
Congenital infections include a well-known group of fungal, bacterial, and viral pathogens eg:
- TORCHS
- Varicella-zoster virus
- Parvovirus / Parvovirus B19
- HIV
- Hepatitis B
- Zika virus
- Neisseria gonorrhoeae
- Chlamydia
- Mycobacterium tuberculosis
Sequelae of Intrauterine Infection (IUI)
Sequelae of Intrauterine infection (IUI) depends on:
- The offending organisms.
- Maternal immunity.
- Gestational age at which infection occurs.
Sequelae of intrauterine infections include:
- Abortion.
- Stillbirth.
- Cong. malformations.
- Acute or delayed disease in the neonatal period.
- Asymptomatic persistent infection with sequelae later in life, or no apparent effect.
- preterm labor
- IUGR
Etiology and Classification by Timing
1) Prenatally (Prenatal Infection)
- Mechanism: By vertical transmission, i.e. transplacentally.
- Pathogens: It includes (TORCHS), as well as other pathogens e.g. parvovirus B19, varicella, Zika virus … etc.
- Manifestations: Prenatal(congenital) and perinatal infections can manifest during pregnancy, as ultrasonographic findings, soon after birth, or later in life.
2) Perinatally (Perinatal Infection)
- Definition: Refers to infections acquired by a baby during pregnancy (transplacentally), delivery, or postnatally (shortly after birth) through breast feeding (less common for congenital infection).
- Impact: They can cause various health problems for the newborn, ranging from mild to severe and in some cases, even be fatal.
- Examples: GBS, E.coli, HIV, HBV, HCV, HSV, gonococcal and chlamydiae infections.
3) Postnatally (Postnatal Infection)
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a) Nosocomial infections: Occur after exposure of the newborn to the infectious agent in the nursery or health care-associated infections or during invasive procedures. Organisms include eg. Staphylococci, E.coli, Klebsiella. Candida and some viruses.
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b) Community acquired infections: Occur after discharging home which mainly include eg. S.pneumoniae and H.influenza.
Maternal and Fetal Manifestations
Manifestations of perinatal infections include:
- Maternal features of sepsis or chorioamnionitis:
- Fever ≥38°C.
- Uterine tenderness.
- Foul smelling vaginal discharge.
- Foul smelling amniotic fluid.
- Maternal leukocytosis.
- Maternal tachycardia.
- Fetal Indicators:
- Fetal tachycardia.
- Fetal U/S findings.
- Newborn feature of infections.