Perinatal infection resident survival guide

Immediate administration of Spiramycin ^[2]

❑ Fetus and Newborn:

Pyrimethamine, Sulfadiazine, and folinic acid.^[2]||

❑ Pregnant mother should avoid contact with cat litter.^[3]

❑ Wash hands more frequently, especially after touching soil gardening.^[3]

Reassurance.

❑ Congenital rubella syndrome: Supportive care and surveillance.

❑ Live, attenuated rubella vaccine is contraindicated during pregnancy ^[4]

❑ Nationally notifiable condition: Suspected congenital rubella syndrome must be reported to the local or state health department.^[5]

• Severe anemia: Intrauterine blood transfusions
• Thrombocytopenia: Platelet transfusions

❑ Newborn:

• Supportive therapy of symptoms,Ganciclovir^[7], Valganciclovir, or Foscarnet

❑ Mother:

• Valacyclovir.

❑ Pregnant women with risk factors for TORCH infection should avoid potentially contaminated workplaces such as schools, paediatric clinics. ^[8]

OR

❑ Acyclovir 200 mg tablets 4 times a day from week 36 until delivery, and viral cultures on cervical-vaginal secretions from 36th week of gestation are required.

❑ Valacyclovir at a dose of 200 mg 2 times a day.^[9]

❑ Cesarean section in women with active genital lesions or prodromal symptoms such as burning pain.

❑ Pregnant women with risk factors for TORCH infection should avoid potentially contaminated workplaces such as schools, paediatric clinics.

The US Public Health Service^[11]published recommendations for the use of ZDV or AZT to reduce the risk of HIV transmission from infected women to their infants as a result of the AIDS Clinical Trials Group (ACTG) which includes:

• Antepartum: ZDV, 100 mg orally five times per day, starting at 14–34 weeks.^[11]
• Intrapartum: ZDV, 2 mg/kg intravenously (IV), loading dose, given over 1 hour, followed by 1 mg/kg/hr IV until delivery.^[11]

❑ Newborn:

ZDV syrup 2 mg/kg orally every 6 hours, beginning 8–12 hours after birth for the first 6 weeks of life

❑ If cesarean delivery is chosen, it should be performed electively at 38 weeks of gestation. ZDV should begin 3 hours prior to delivery. It is important to use perioperative prophylactic antibiotics to reduce maternal infectious morbidity.

❑ The management of labor should include avoidance of scalp electrodes and scalp sampling.

❑ Breastfeeding is not recommended when there is a suitable alternative.

❑ Even if she is asymptomatic after delivery, she will require support and surveillance for disease progression.^[13]

Administer postexposure prophylaxis in newborns if mother displays symptoms of varicella up to 7 days before delivery or up to 28 days after delivery: IgG antibodies (varicella-zoster immune globulin, VZIG)^[15]

VZIG in pregnant women without immunity within 10 days of exposure.^[17]

❑ Maintain hygienic practices such as hand washing with safe water, particularly before handling food, avoiding drinking water or using ice cubes of unknown purity, and avoiding eating unpeeled fruits and vegetables.

❑ The HAV vaccine is safe and develops protective levels of antibodies 2 weeks after the first dose of the vaccine and persists at least 10 to 29 years, if not lifelong after receiving the second dose. So, it should be administered before travelling to endemic areas.^[18]

Hepatitis B:

❑ Testing for HBV surface antigen is recommended as a part of routine prenatal testing.

❑ Infants born to HBV-positive mothers should receive 0.5 mL of hepatitis B immune globulin within 12 hours of birth and simultaneously receive the first dose of HBV vaccine (half the adult dose). The remaining doses should follow the adult schedule. Complete immunization requires the initial dose with repeated doses at 1 and 6 months.

Hepatitis C:

❑ At present, no vaccine is available for HCV .

❑ Trans placental transfer of oseltamivir to fetus may occur. But there is no evidence of adverse fetal outcomes as of now.^[19]

❑ Penicillin G 5 million units intravenous is administered as a loading dose, followed by 2.5 to 3 million units every 4 hours during labor until delivery.^[21][20]

❑ Ampicillin is a reasonable alternative to penicillin G, which is administered as a 2 gm intravenous loading dose followed by 1 gm intravenous every 4 hours during labor until delivery.

❑ Antibiotic prophylaxis in patients with a history of anaphylaxis, angioedema, respiratory distress, or urticaria following penicillin or cephalosporin is guided by antibiotic susceptibility testing. If GBS is sensitive to both clindamycin and erythromycin, then clindamycin 900 mg intravenous every 8 hours is recommended for GBS prophylaxis during labor until delivery.^[20][21]

❑ If the culture returns resistant to erythromycin, vancomycin 1 gm intravenously every 12 hours is recommended for GBS prophylaxis.

❑ If patient is penicillin allergic, vancomycin is the choice of treatment.

❑Cefazolin 2 gram intravenous loading dose followed by 1 gm every 8 hours may be used in patients without a history of anaphylaxis, angioedema, respiratory distress, or urticaria following penicillin or cephalosporin administration.^[20]

• Avoidance of potentially contaminated water and food: See “Food and water safety” in food poisoning.
• Nationally notifiable condition: Listeriosis must be reported to the local or state health department.^[22]

• Nationally notifiable condition: Congenital syphilis and syphilitic childbirth must be reported to local or state health department.^[25]

• Ceftriaxone, 125 mg IM, single dose
• Cefixime, 400 mg orally, single dose
• Spectinomycin, 2 g IM, single dose (for patients who cannot tolerate a cephalosporin).

In addition, treatment for Chlamydia should be administered because of the likelihood of coinfection. Disseminated infection in the newborn requires high-dose treatment, and ophthalmic infection should be treated both locally and systemically.

• Erythromycin base, 500 mg,or erythromycin ethylsuccinate, 800 mg orally four times daily for 7 days Amoxicillin, 500 mg orally three times daily for 7 days Azithromycin, 1 g orally as a single dose

❑ Alternate antibiotics are ampicillin or amoxicillin

❑ Combination of trimethoprim and sulfamethoxazole is useful for resistant strains but avoided in pregnancy if possible.

❑ Aspirin should be avoided because patients with typhoid are extremely sensitive and severe hypothermia may occur.

❑ The use of N,N-Diethyl-meta-toluamide, which has been recommended in pregnancy to prevent ZIKA infection.

❑ Long sleeves and pants or permethrin-treated clothing.

❑ Use of mosquito nets and window screens if living in or traveling to an endemic area.

❑ If the pregnant woman is living in an endemic area, areas of standing water such as tires, buckets, planters should be eliminated because they are a breeding area for mosquitoes.

❑ All pregnant women and their partners should receive counseling on prevention measures including avoidance of mosquito bites and sexual transmission.

❑ If a couple has a male partner and he travels to an area with ZIKA Virus, they should use condoms or abstain from sexual activity for 6 months (even if there is no symptoms).

❑ If a female travels to an area with risk of ZIKV, condoms or abstinence from sexual activity for 8 weeks (even in the absence of symptoms) is recommended.

❑ If a pregnant patient and her partner travel to or live in an area with Zika virus, condoms should be used each time the couple has sex for the remainder of pregnancy, or they should abstain from sexual activity. ^[27]