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 ?
Answer
Cerebral
calcifications are most in:
Congenital toxoplasmosis
CMV
Occasionally with congenital HSV
Rarely congenital Rubella infection
Question ?
What are
the late sequelae of congenital infections ?
Answer
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
Answer
CMV
: Hearing Loss
Minimal to sever brain dysfunction :
Motor , learning , language & behavioral disorders
Answer
Rubella :
Hearing Loss
Minimal to severe
brain dysfunction :
Motor , learning ,
language & behavioral disorders
Autism , juvenile
diabetes , thyroid dysfunction , precautious puberty , progressive
degenerative brain disorder
Answer
Toxoplasmosis :
Chorioretinitis :
Minimal to sever brain dysfunction
Hearing Loss
Precautious puberty
Answer
Neonatal Herpes:
Recurrent eye & skin infection
Minimal to sever brain dysfunction
Answer
Hepatitis B virus :
Chronic sub clinical Hepatitis
Rarely Fulminant Hepatitis
Question ?
What is the most
common congenital infection ?
Answer
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 ?
Answer
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 ?
Answer
Treatment is
recommended with :
Life or Vision
Threatening disease
Such as:
Retinitis
Interstitial
pneumonitis
Hepatitis
Thrombocytopenia
Question ?
What is the Risk to
the Fetus if the mother is infected with Parvovirus B19 during
pregnancy ?
Answer
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
Answer
an elevated
maternal serum alpha-fetoprotein level
The signs
of parvovirus in adults:
Fefer
Maculo papular or
lace-like Rash
Joint pain
Question ?
What are the
consequences of primary Varicella infection during the 1st
trimester ?
Answer
The
congenital variclla Syndrome :
Lim atrophy
Neurologic &
sensory defects
Eye
abnormalities
Chorioretinitis
Cataracts
Microphtalmia
Horner syndrome
Question ?
When should VZIG be
given to a newborn ?
Answer
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
Answer
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 ?
Answer
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 ?
Answer
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 ?
Answer
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 ?
Answer
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 ?
Answer
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 ?
Answer
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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