Elsevier

Clinics in Perinatology

Volume 33, Issue 4, December 2006, Pages 871-882
Clinics in Perinatology

Infection in Late Preterm Infants

https://doi.org/10.1016/j.clp.2006.09.005Get rights and content

Section snippets

Congenital and perinatal infections

These infections are acquired before delivery or during the intrapartum period. They result most commonly from Toxoplasma gondii, rubella virus, cytomegalovirus, herpes virus, HIV, parvovirus B19 and Treponema pallidum. Risk of transmission varies depending on trimester of pregnancy during which maternal infection occurs. Toxoplasma transmission rates range from less than 5% during the first trimester to approximately 60% in the third trimester [1]. Severity of the infection also depends on the

Congenital and perinatal infections

Although caused by various organisms, congenital and perinatal infections may present with similar clinical findings. Infections that are acquired before delivery (eg, cytomegalovirus, rubella, toxoplasmosis, and syphilis) often present with a combination of findings including intrauterine growth restriction, jaundice, rash, intracranial calcifications, microcephaly, chorioretinitis, and thrombocytopenia. Hepatosplenomegaly, although a nonspecific finding, should encourage thorough evaluation

Congenital infections

High pretest probability for congenital infections may be achieved through clinical presentation and a review of the maternal history; history and physical examination often provide guidance as to which laboratory tests should be obtained. Diagnostic methods for congenital infections have advanced substantively in the polymerase chain reaction (PCR) era [19], [20], [21], [22], [23]. HIV should be diagnosed by means of DNA PCR. Herpes virus can be diagnosed by DNA PCR of cerebrospinal fluid

Antimicrobial therapy

Therapy may be considered broadly as definitive, presumptive, empirical, and prophylaxis. Definitive treatment is the administration of antimicrobial agents for documented disease (eg, administration of ampicillin and gentamicin for 10 days because GBS has been isolated from the blood). Presumptive therapy is administered when the clinician strongly suspects disease, but the documentation is incomplete. For example, an infant has a positive blood culture for GBS; due to clinical instability, a

Congenital infections

If congenital nonbacterial infection is suspected, it is often prudent to seek the advice of infectious disease specialists. Treatment for possible exposure to several agents (HIV, herpes virus, toxoplasmosis, and Treponema pallidum) often is indicated. Transmission of HIV has been reduced from almost a third to less than 2% through a series of interventions including maternal antenatal and intrapartum and neonatal antiretroviral therapy and delivery by cesarean section. Recent cohort data have

Congenital infections

Prevention of HIV infection in the exposed neonate has been a remarkable achievement. The neonatologist can help to ensure prevention of maternal–infant transmission by advocating for routine testing of pregnant women and follow-up of infected pregnant women, timely and appropriate therapy with antiretroviral drugs, collaboration with obstetrical and infectious disease colleagues for mothers in labor and infants in the peripartum period, and follow-up for the infant after discharge from the

Summary

Evaluation of the infant with possible infection should include careful review of the maternal and perinatal history and an assessment of the symptoms of infection exhibited by the neonate. A diagnostic evaluation for congenital infections should be considered in neonates who have intrauterine growth restriction and multi-organ involvement. Evaluation for potential sepsis in neonates should include blood and CSF cultures and urine cultures in neonates older than 72 hours of age. Prompt

First page preview

First page preview
Click to open first page preview
View PDF

References (41)

  • Centers for Disease Control and Prevention

    Prevention of perinatal group B streptococcal disease

    MMWR Morb Mortal Wkly Rep

    (2002)
  • Centers for Disease Control and Prevention

    Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC

    MMWR Recomm Rep

    (2002)
  • B.J. Stoll et al.

    Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants

    N Engl J Med

    (2002)
  • M.J. Bizzarro et al.

    Seventy-five years of neonatal sepsis at Yale: 1928–2003

    Pediatrics

    (2005)
  • H.P. Garges et al.

    Neonatal meningitis: what is the correlation between cerebrospinal fluid cultures, blood cultures, and CSF parameters?

    Pediatrics

    (2006)
  • L.M. Luginbuhl et al.

    Neonatal enterococcal sepsis: case–control study and description of an outbreak

    Pediatr Infect Dis J

    (1987)
  • B.S. Harvey et al.

    Contributions of complement and immunoglobulin to neutrophil-mediated killing of enterococci

    Infect Immun

    (1992)
  • D.K. Benjamin et al.

    Mortality following blood culture in premature infants: increased with gram-negative bacteremia and candidemia, but not gram-positive bacteremia

    J Perinatol

    (2004)
  • B.J. Stoll et al.

    Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network

    Pediatrics

    (2002)
  • D.K. Benjamin et al.

    Empirical therapy for neonatal candidemia in very low birth weight infants

    Pediatrics

    (2003)

    • Cited by (47)

    • Diagnostic accuracy of serum (1,3)-beta-D-glucan for neonatal invasive candidiasis: systematic review and meta-analysis

      2020, Clinical Microbiology and Infection
      Citation Excerpt :

      Candida species are the third most common infectious agents isolated in late-onset neonatal sepsis [1], with C. albicans and C. parapsilosis accounting for 80–90% of neonatal fungal infections [2]. In the USA, the incidence of NIC varies between 3% and 10% for very low birth weight neonates (VLBW; 1000–1500 g) and between 6 and 20% for extremely low birth weight neonates (ELBW; <1000 g) [1,3]. NIC is a severe illness, with a case fatality rate up to 30% [4], and carries an additional risk of subsequent neurodevelopmental impairment due to Candida spp. meningoencephalitis [4].

    • Follow-up recommendations for the late preterm infant

      2019, Anales de Pediatria

    • Late Preterm Infants

      2018, Avery's Diseases of the Newborn: Tenth Edition

    • Late Preterm Infants

      2017, Avery's Diseases of the Newborn, Tenth Edition

    • Needs Perceived by Parents of Preterm Infants: Integrating Care Into the Early Discharge Process

      2016, Journal of Pediatric Nursing

    • Antenatal corticosteroid therapy and late preterm infant morbidity and mortality

      2014, Anales de Pediatria
    View all citing articles on Scopus

    Dr. Benjamin received support from NICHD HD-044799-01.

    View full text
    Copyright © 2006 Elsevier Inc. All rights reserved.