Incidence, clinical spectrum, and outcome of intrauterine infections in neonates

A prospective study was undertaken on the incidence of intrauterine infecti ons by screening 1302 cord blood samples for total IgM by radial immunodiff usion, Specific IgM against cytomegalovirus (CMV), rubella and Toxoplasma w ere estimated in cord blood samples found to contain total IgM >20 mg/dl. A ll these neonates were examined at birth and at discharge. Cord blood sampl es with total IgM > 20 mg/dl were further screened for specific IgM against rubella, CMV and Toxoplasma. Neonates found to have positive specific IgM were followed-up for hearing, opthalmological and developmental assessment. Raised cord blood (IgM > 20 mg/dl) was found in 270/1302 (20.6 per cent). Mean birth weight was comparable in babies with raised ( > 20 mg/dl) or low ( <20 mg/dl) cord blood total IgM. incidence of prematurity and low birth weight were not statistically different in babies with raised cord blood Ig M when compared to those with low cord blood IgM levels. Similarly, inciden ce of intrauterine growth retardation (IUGR) idiopathic was similar in two groups. Specific IgM for rubella was found to be positive in eight (0.6 per cent). Of these, three had symptomatic rubella infection, Two mothers of t hese symptomatic babies had exanthematous viral illness during first trimes ter. Specific IgM for CMV was found to be positive in 23 (1.8 per cent) whi le two infants had symptomatic CMV disease. None of the babies was found to have specific IgM against Toxoplasma. One baby with symptomatic CMV diseas e and one with rubella died, Another baby with symptomatic CMV disease deve loped neonatal hepatitis which improved on follow-up but the infant went on to develop sensorineural deafness. All other asymptomatic babies with spec ific IgM positive against rubella and CMV were found to have normal vision, hearing and development on follow-up.