PRENATAL AND PERINATAL INFECTIONS - PROBL EMS FOR THE PRACTICING PEDIATRICIAN - GROUP-B STREPTOCOCCI, VARICELLA, TOXOPLASMOSIS

A practical approach is reported for the care of the neonate born to a mother infected/colonized during pregnancy by group B streptococcus, varicella-zoster virus or Toxoplasma gondii. Starting from clinical si tuations, an attempt is made to work out evidence based recommendation s using an overview of the current literature. Group B streptococci: R elevant factors for the treatment of infants born to colonized mothers are clinical symptoms, gestational age, additional risk factors (such as premature rupture of membranes or maternal fever) and intrapartum antibiotics. Postnatal antibiotic prophylaxis and laboratory screens f ailed the test of controlled trials. Transfer to a neonatology unit is recommended for symptomatic term and all preterm infants. Asymptomati c term infants should be carefully monitored during the first 48 hours for signs of respiratory, circulatory or thermoregulatory compromise. Varicella: In the case of maternal varicella near term, delaying deli very for one week will lower the risk of severe neonatal varicella. Th e postnatal administration of varicella-zoster-immunoglobulin to the n eonate is supported by some (if limited) evidence from the literature in the case of maternal eruption between 7 days before and 2 days afte r delivery. In newborns of mothers with eruption appearing later immun oglobulin is often recommended, though no supporting clinical evidence is available. There are no data to justify the use of immunoglobulin after exposure during pregnancy in order to prevent pneumonia in the p regnant patient, but there are preliminary indications that its applic ation could lower the risk of congenital varicella syndrome (2% betwee n 13 and 20 weeks). The use of immunoglobulin in very low birth weight infants after nosocomial exposure is generally recommended but effica cy data are lacking. Toxoplasmosis: The practical approach depends on clinical findings in the newborn and laboratory results during pregnan cy and after birth. Examination of the newborn should include fundosco py, cranial sonography and, in cases of documented infection, lumbar p uncture. Serology from cord blood comprises assays for IgG, IgM and if possible IgA/IgE. If available, demonstration of the parasite by cult ure or PCR can be helpful. All infants with documented congenital toxo plasmosis should be treated for a minimum of 12 months. In the case of suspected toxoplasmosis the child should be treated as long as the su spicion persists. The prognosis after consequential therapy is less bl eak than previously reported for untreated children even in seriously symptomatic patients.