Question & Answer NB

  Mohammad H. Soltanzadeh , MD,ID

        Professor of Pediatrics,  Shaheed  Beheshti  University

         Of Medical Sciences  , Tehran , IRAN

Question ?

Which congenital infections cause cerebral calcifications ?


  Cerebral calcifications are most in:

Congenital toxoplasmosis


Occasionally with congenital HSV

Rarely congenital Rubella infection

Question ?

What are the late sequelae of congenital infections ?


 The late sequelae of chronic IUI are relatively common

 May occur in infants who are asymptomatic at birth

 Most sequelae present symptoms later in childhood  rather than in infancy 


CMV : Hearing Loss

Minimal to sever brain dysfunction :

Motor , learning , language & behavioral disorders



   Rubella : Hearing Loss

  Minimal to severe  brain dysfunction :

   Motor , learning , language & behavioral disorders

   Autism , juvenile diabetes , thyroid dysfunction , precautious puberty , progressive degenerative brain disorder


   Toxoplasmosis : Chorioretinitis :

Minimal to sever brain dysfunction

Hearing Loss

Precautious puberty


Neonatal Herpes:

Recurrent eye & skin infection

Minimal to sever brain dysfunction


Hepatitis B virus :

Chronic sub clinical Hepatitis

Rarely Fulminant Hepatitis

Question ?

 What is the most common congenital infection ?


Congenital CMV infection

Occurs 1.3% of newborns

90-95 % are Asymptomatic

Later develop Hearing Loss

Question ?

How is CMV transmitted from mother to infant ?


   CMV can transmitted by the :

   Trans placental  route

   Through contact with cervical secretions

   Breast Milk

   on occasion contact with Saliva or Urine

Question ?

 Should congenital CMV be Treated ?


   Treatment is recommended with :

   Life or Vision Threatening disease

   Such as:


   Interstitial pneumonitis



Question ?

 What is the Risk to the Fetus  if the mother is infected with Parvovirus B19 during pregnancy ?


   The Risk of fetal loss  is 2-10%

   Greatest when maternal infection occurs during the 1st half of pregnancy

  Fetal loss occurs a consequence of hydrops

  Develops as a result of parvovirus induced anemia


 an elevated maternal serum alpha-fetoprotein level

   The signs of parvovirus in adults:


 Maculo papular or lace-like Rash

 Joint pain

Question ?

 What are the consequences of primary Varicella infection during the 1st trimester ?


  The congenital variclla Syndrome :

   Lim atrophy

   Neurologic & sensory defects

   Eye abnormalities




   Horner syndrome

Question ?

 When should VZIG be given to a newborn ?


   VZIG should be given as soon as possible to a newborn whose mother :

   Developed varicella from 5 days before to 2 days after delivery

   During this period of high Risk

   The fetus is exposed to high circulating titers of the virus


   Premature neonates exposed to varicella the neonatal period are also candidates for VZIG

   If the infant is > 28 wks gestation & mother has no history of chickenpox

   If the infant is < 28 wks gestation or

   weight < 1000 Gr regardless of maternal  history

Question ?

What is indication for Oral Acyclovir in Varicella – Zoster virus infections ?


 Patients > 12 yrs old

 Patients with chronic pulmonary or cutaneous diorders

 Patients receiving long- term salicylate therapy

 Patients receiving corticosteroids ( oral or aerosolized )

Question ?

 How should infants born to mothers with Hepatitis A infection be managed ?


 Neonates born to mothers with Hepatitis A infection are :

 Unlikely to contract the Virus.

 Efficacy of postnatal prophylaxis with Hepatitis A immune globulin has not been proven .

 No prophylaxis is recommended.

Question ?

 How should infants born to mothers with Hepatitis B infection be managed ?


 For infants born to women who are HBsAg-positive :

 HBIG  0.5 ml IM

1st dose Vaccine within 12 hrs

 BM is capable of transmitting the Hepatitis B virus

 BF  is not contraindicated. 

Question ?

 How should infants born to mothers with Hepatitis C infection be managed ?


   The risk of vertical transmission of Hepatitis C virus approximately 5%

   No preventive therapy exists .

   Transmission by BF has not been documented

   Is not contraindication to BF

   Mothers with cracked or bleeding nipples should consider abstaining

Question ?

 If a pregnant women is found to have Chlamydia trachomatis  in her birth canal, what is most appropriate course of action ?


   A pregnant women with chlamydial should be treated with :

   Oral Erythromycin , Azithromycin , or Amoxicillin

   Treatment of the male partner  should be :

   Doxycyclin 100mg twice daily or

   Azithromycin 1 gm single dose  

Question ?

 What is the risk to a fetus after primary maternal Toxoplasmosis infection ?


    The risk depends on the time during pregnancy that the mother becomes infected

    1st trimester infections associated with a fetal infection

    Rate of approximately 25%

    2nd trimester > 50%

    3rd trimester    65%

    Severity related to gestational age & time of primary maternal infection


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