Anti microbial selection 1. E.Coli, Klebsiella, Shigella & Salmonella : Amnioglycorides or 3’rd generation Cehalosponis. 2. Haemophilus Influenza : Ampicillin & 3’rd generation Cehalosponis. Sometimes ampicillin are resistant. 3. Pseudomonas : Amnioglycorides + anti pseudomonas pencillin. 4. Bacteroides Fragilis : Metronidazole, clindamycin, some beta lactomoses such as imipenum & ampicillin with sulbactim & chloramphenicol.
Group B Streptococcus Group b streptococcus hemolytic streptococci were unknown to the perinatal scene until there early 1970’s where they replaced E.Coli as the single most common agent associated with bacterial meningitis during the 1’st 2 months of life.
Pathophysiology Intensity of the maternal colonization is directly Related to risk of invasive disease in the neonate because of low & high density colonization Risk of amniotic fluid contaminated with meconium or vernix caseosa which promotes the growth of the GBS & E.Coli
Conts…. Few organisms in the vaginal vault due to the PMOM Possibly contributing to the paradox. Organisms usually reach the blood stream by fetal aspiration or swallowing of the contaminated amniotic fluid Leading to bacteremia.
Escherichia Coli E.Coli is a gram negative, non spore forming motile rod. It is a normal inhabitant of the gastro intestinal tract & most common cause of the gram negative infection in the new born.
Listeria Monocytogenes 1. It is found in the birds & mammals, including domestic and farm animals. 2. It is found in the unpasteurized milk, soil and fecal matter. 3. The infection appears to be undiagnosed and an underreported cause of the congenital infection.
Neonatal meningitis A neonatal bacterial meningitis is the inflammation of the meninges due to the bacterial invasion. Meningitis can be a sequence of the new born infection.
Toxoplasmosis The importance of the parasite toxoplasma gondii was discovered by health care worker through the perinatal death.
Management 1. Prevention & early recognition. 2. Mother at a risk should avoid soil digging, handling or cooking under cooked meat. 3.If the signs of infection exhibit then report immediately. 4.Congenital toxoplasmosis : Pyrimethamine + Sulfonamides. 2mg/kg/day, orally for 2 days, followed by 1mg/kg/day for 2 or 6 months, then 1mg/kg/day every Monday, Wednesday and Friday for a year period.
Conts… 5.Doses of 100mg/kg/day is divided into 2 doses for 1 year. 6.Levovorin 10 mg is given 3 times weekly & for 1 week after Pyrimethamine therapy. 7.Corticosteroids are given in the form of predinose at 1 mg/kg/day in 2 divided doses until there is a resolution of elevated protein in CSF.
RUBELLA Congenital rubella is a viral infection acquired from the mother during pregnancy. It has been established that the rubella virus can be responsible for other abnormalities.
Management 1.Avoid pregnancy for atleast 2 months after immunizations to decrease the risk of rubella syndrome. 2.If the women receives rubella or RHoGAIG (RhIG). The vaccine may not trigger an immune response because blood products & RHoGAIG have pooled sera that may contain antibodies against rubella. Thus the women does not produce antibodies. 3.Trites should be drawn between 6 weeks after the vaccination or at most after 3 weeks.
Conts…. 4.Vaccination is not recommended in pregnancy but in case if they don’t wish to continue the pregnancy they go for the vaccination. 5.Avoid contacts with the patients. 6.Follow up for the children for the cardiac problems & cataracts should be done.
Cytomegalo virus Infection with cytomegalovirus, a member of the herpes family, is common. CMV is a DNA virus covered with a glycoprotein coat that closely resembles the herpes & varicella zoster virus. CMV infection is more prevalent in lower economic group & especially common in the developing countries.
Introduction Neonatal herpes simplex virus infection is usually transmitted during delivery. HSV is a member of a family of the large DNA virus. They contain linear, double strands of DNA. The herpes family also includes CMV, Varicella-Zooster & Epstein-Barr Virus.
Management 1. Antiviral drug: Acyclavir & Vidarabine. 2. Vidarabine: 15-30mg/kg/day/IV, over a period of 10-14 days for 12 hours. 3. Acyclavir: 30mg/kg/day/IV divided over 8 hours for 10 to 14 days. it helps in decreasing the reactivation of the virus particularly in the treatment of herpes simplex encephalitis. 4.Eye: Trifluridine, 1 drop every 2 hours, as well as IV therapy.
Other’s 1.Isolation : viral shedding provides an reservoir for infecting others. 2.Family education & support. 3.Hand washing techniques. 4.Positive cultures at birth may just reflect colonization, cultures should be repeated at 24 to 48 hours.
Hepatitis virus It is a double stranded DNA containing virus exposure to infected blood & body fluids, percutaneous introduction of blood & administration of infected blood products are the principal routes of transmission.
Chlamydia Chlamydia trachomatis infection has been identified as causing significant increase in the incidence of PROM, the number of low birth weight babies and the rate of infant mortality.
Candida Albicans It is the more prevalent form in the neonates. Candida organisms are oval, yeast like cells that can bud to reproduce C-Albican producers endotoxican, hemolysis, pyrogen & protrolytic enzymes that are damaging to the tissues.