58 Assessment of the Mother, Fetus, and Newborn

C113

59 Maternal Diseases Affecting the Newborn

60 Diseases of the Fetus

61 Respiratory Diseases of the Newborn

N124-133 Newborn Respiratory Problems

62 Anemia and Hyperbilirubinemia

63 Necrotizing Enterocolitis

64 Hypoxic-Ischemic Encephalopathy, Intracranial Hemorrhage, and Seizures

65 Sepsis and Meningitis

66 Congenital Infections

C131

C131.1 Congenital Infections

• Bacteria
  • Listeria monocytogenes (Chapter 215 ) 
  • Syphilis (Treponema pallidum ) (Chapter 245)
• Viruses
  • Cytomegalovirus (Chapter 282) 
  • Hepatitis B (Chapter 385) 
  • Hepatitis C (Chapter 385) 
  • Herpes simplex virus (Chapter 279 ) 
  • Human immunodeficiency virus (Chapter 302 ) 
  • Human parvovirus B19 (Chapter 278) 
  • Lymphocytic choriomeningitis virus (Chapter 298 ) 
  • Rubella (Chapter 274 )
  • Varicella-zoster virus (Chapter 280 ) 
  • Zika virus (Chapter 294.12 )
• Parasite
  • Toxoplasmosis (Toxoplasma gondii ) (Chapter 316)

Differential diagnosis

• Listeriosis
  • CNS disease, meningitis : at 3 days (preterm) ~ 3 weeks age (full term)
    disseminated organ involvement (i.e., liver and lung)
  • Chorioamnionitis & PPROM ✅
  • IV ampicilin + gentamicin
• Syphillis
  • CNS disease – rare
    Hepatomegaly
  • Chorioamnionitis & PPROM ❌ Miscarriage, stillbirth, hydrops fetalis ✅

• HSV
  • CNS disease (fever, seizure, hypotonia) : at 2-3 weeks age
    Sepsis-like disseminated disease (e.g., hepatomegaly, pneumonitis)
    Vesicular skin lesion, keratoconjunctivitis
  • Chorioamnionitis & PPROM ❌
• Parasite – Toxoplasmosis (oplasma gondii)
  • Mononucleosis-like disease
  • Severity decreases with gestational age
    • Infection in 1st trimester: classic triad (chorioretinitis, intracranial calcification, hydrocephalus) + other nonspecific Sx (blueberry muffin rash, jaundice)
    • Infection in 2nd-3rd trimester: mostly subclinical or mild.
  • Chorioamnionitis & PPROM ❌

C131.2 Perinatal Infections

• Chlamydia trachomatis (Chapter 253 ) 
• Escherichia coli (Chapter 227 ) 
• Genital mycoplasmas (Chapter 251 ) 
• Group B streptococci (Chapter 211 ) 

	Early onset (age <7 days)	Late onset (age >7 days)
Pathogenesis	Vertical transmission in utero or during vaginal delivery Reduced transmission with maternal intrapartum antibiotic prophylaxis	Horizontal transmission from colonized individuals
Clinical features	Typically presents within 24 hours Sepsis, pneumonia, meningitis	Typically presents age 4-5 weeks Bacteremia, meningitis, focal infection (eg, cellulitis, adenitis, osteomyelitis)

• Diagnosis: Gram-positive cocci in pairs and short chains on culture of blood, CSF, or body fluid
• Treatment
  • Early initiation of empiric antibiotics
    Definitive therapy with penicillin G

• Neisseria gonorrhoeae (Chapter 219 ) 
• Syphilis (Treponema pallidum ) (Chapter 245 )

Viruses

• Cytomegalovirus (Chapter 282 ) 
  • At birth, 90% are asymptomatic.
    Blueberry muffin rash, jaundice, small size for gestational age, microcephaly, sensorineuronal hearing loss. Periventricular calcifications and hydrocephalus
  • Chorioamnionitis & PPROM ❌

• Enteroviruses (Chapter 277 ) 
• Hepatitis B (Chapter 385) 
• Herpes simplex virus (Chapter 279 ) 
• Human immunodeficiency virus (Chapter 302 )

Fungi

• Candida spp. (Chapter 261 )