MATERNAL CAUSES OF

NEONATAL INFECTIONS

Professor David Woods

Neonatal Medicine Department
University of Cape Town
South Africa
• Chronic transplacental infections:

– Viruses: HIV, rubella, CMV

– Spirochaetal: syphilis
– Protozoal: Toxoplasmosis
– Rarely bacterial: TB

• Acute ascending transcervical bacterial

infection

• Contamination in the birth canal:

– Neisseria gonorrhoeae (Gonococcus)

– Chlamydia trachomatis
– Group B Streptococcus
– Herpes simplex
 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 <5% with correct management

 Rubella

• Preventable with routine immunisation

• Risk of congenital malformations with first trimester

infection

• Chronic fetal infection alone with second trimester

infection
• Neuronal deafness 60%
• Congenital heart disease 50%
• Microphthalmia with cataracts 40%

• IUGR with hepatosplenomegaly

• Microcephaly with mental retardation
• Thrombocytopenia
• Blue berry muffin rash
 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 or

benzyl penicillin
 Neonatal conjunctivitis
• Gonococcus or Chlamydia
• Usually no history or signs of maternal
infection
• 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
• 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
 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
 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
 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