Congenital, Perinatal & Neonatal infection (incl. TORCH)

Question 1

Define congenital infection.

Answer 1

Antenatal transmission of maternal infection to the fetus.

Question 2

Define perinatal infection.

Answer 2

Infection of liveborn baby from 20 weeks of gestation up to 7 days after birth.

Question 3

Define neonatal infection.

Answer 3

Infections occurring up till the first 28 days after birth.

Question 4

What is TORCH?

Answer 4

Toxoplasmosis, others (syphilis, Hep B), rubella, CMV and herpes simplex.

Question 5

Explain the aetiology for congenital infection.

Answer 5

Occurs via transplacental transmission.

• CMV: If mother is infected in the first trimester the rate of transmission to the fetus is much greater than in the third trimester.
• Rubella: Increased teratogenic effect during early gestational age. Above 18 weeks of gestation there is a low risk of congenital malformations.
• Syphilis: Almost100% transmission rate between mother and foetus.

Question 6

What are risk factors for congenital infection?

Answer 6

Lower socio-economic groups

Developing countries

Mothers who are not vaccinated or are immunosuppressed

Question 7

Explain the aetiology/risk factors for perinatal and neonatal infection.

Answer 7

Can occur during labour, amniocentesis or major trauma.

• Hep B, HIV and other sexually transmitted infections.

Neonatal infections can also occur from hospital environment (i.e. unrelated to the birth).

Low maternal immunity is a risk factor.

GBS is carried naturally but can be harmful to the baby.

Question 8

Summarise the epidemiology of congenital infections.

Answer 8

CMV is common (4% of live births), the other TORCH infections are rare.

Question 9

What are signs and symptoms of CMV infection?

Answer 9

• Hepatosplenomegaly
• Hematological: Thrombocytopenia
• Petechiae and purpura (Blueberry muffin baby)
• CNS manifestations (Microcephaly, chorioretinitis, encephalitis, sensorineural deafness)

Question 10

What are signs and symptoms of rubella infection?

Answer 10

• Sensorineural deafness
• Occular: Cataracts, infantile glaucoma, chorioretinits, retinitis pigmentosa.
• Cardiac: PDA, pulmonary artery stenosis, ASD, VSD.
• IUGR, hypotonia, microcephaly, hepatomegaly, jaundice, hepatitis.

Question 11

What are signs and symptoms of syphillis?

Answer 11

• Mucocutaneous lesions – Mucous patches, rhinitis and condylomas.
• Neurosyphilis in late stage – Eyes, cranial nerve 8th palsy

Question 12

What are other signs and symptoms of congenital, perinatal and neonatal infection?

Answer 12

May cause spontaneous abortion or still-birth in some cases.

• Septic shock: Tachycardia, tachypnoea, irritability, poor feeding.
• Meningitis: rash, convulsions, depressed consciousness, bulging fontanelle.
• Pneumonia
• UTI

Question 13

What antenatal investigations can be performed for infection (incl. TORCH)?

Answer 13

Amniotic fluid culture.

Question 14

What immediate investigations can be performed for infections (incl. TORCH)?

Answer 14

Immediate: ABCDE approach

• Urine culture: If necessary take a suprapubic culture.
• Bloods: FBC, CRP, U&Es, blood cultures, blood gases.
• Swabs: ENT swabs and other sites of infection.
• Lumbar puncture: LP is recommended in every case of neonatal sepsis (refer to sepsis).
• CXR

Question 15

What specific tests can be performed for infection (incl. TORCH)?

Answer 15

• Virology: Viral, spirochetes from saliva, tears, urine or CSF for PCR/NAAT.
• Bloods: Serum IgM or IgG. Specific tests for each virus.
• Imaging: Abdominal USS, ECHO, CXR and CT.

Question 16

What is the management for congenital, perinatal and neonatal infection (incl. TORCH)?

Answer 16

Refer to investigations section above.

Start empiric treatment

• Sepsis: Cefotaxime
• Meningitis: Cefuroxime + ampicillin
• UTI: IV cefotaxime

MDT: Need to refer to specialists to treat both infection and the consequences.

Medical: Optimise the patient. Treat the infection with anti-viral or benzathine penicillin (for syphilis).

Surgical: Cardiac defects, cataracts removal, enteral supplementation.

Question 17

What are the prognosis of infections (incl. TORCH)?

Answer 17

Dependent on the infection and how early it is caught.

Intracerebral calcifications typically demonstrate a periventricular distribution and are a poor prognostic sign in congenital CMV infection. First year congenital rubella mortality: 10–20%.