Infection in Late Preterm Infants
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
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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 InfectionCitation 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 PediatriaLate Preterm Infants
2018, Avery's Diseases of the Newborn: Tenth EditionLate Preterm Infants
2017, Avery's Diseases of the Newborn, Tenth EditionNeeds Perceived by Parents of Preterm Infants: Integrating Care Into the Early Discharge Process
2016, Journal of Pediatric NursingAntenatal corticosteroid therapy and late preterm infant morbidity and mortality
2014, Anales de Pediatria
Dr. Benjamin received support from NICHD HD-044799-01.