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Current Opinion in Infectious Diseases Oct 2023Congenital infections are a major cause of childhood multidomain neurodevelopmental disabilities. They contribute to a range of structural brain abnormalities that can... (Review)
Review
PURPOSE OF REVIEW
Congenital infections are a major cause of childhood multidomain neurodevelopmental disabilities. They contribute to a range of structural brain abnormalities that can cause severe neurodevelopmental impairment, cerebral palsy, epilepsy, and neurosensory impairments. New congenital infections and global viral pandemics have emerged, with some affecting the developing brain and causing neurodevelopmental concerns. This review aims to provide current understanding of fetal infections and their impact on neurodevelopment.
RECENT FINDINGS
There are a growing list of congenital infections causing neurodevelopmental issues, including cytomegalovirus, Zika virus, syphilis, rubella, lymphocytic choriomeningitis virus, and toxoplasmosis. Fetal exposure to maternal SARS-CoV-2 may also pose risk to the developing brain and impact neurodevelopmental outcomes, although studies have conflicting results. As Zika virus was a recently identified congenital infection, there are several new reports on child neurodevelopment in the Caribbean and Central and South America. For many congenital infections, children with in-utero exposure, even if asymptomatic at birth, may have neurodevelopmental concerns manifest over time.
SUMMARY
Congenital infections should be considered in the differential diagnosis of a child with neurodevelopmental impairments. Detailed pregnancy history, exposure risk, and testing should guide diagnosis and multidisciplinary evaluation. Children with congenital infections should have long-term follow-up to assess for neurodevelopmental delays and other neurosensory impairments. Children with confirmed delays or high-risk should be referred for rehabilitation therapies.
Topics: Infant, Newborn; Pregnancy; Child; Female; Humans; Zika Virus Infection; COVID-19; SARS-CoV-2; Pregnancy Complications, Infectious; Communicable Diseases; Zika Virus
PubMed: 37466092
DOI: 10.1097/QCO.0000000000000946 -
BJOG : An International Journal of... Feb 2024A systematic review with met-analysis was performed to summarise the evidence on the effect of intrapartum azithromycin on maternal and neonatal infections and deaths. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
A systematic review with met-analysis was performed to summarise the evidence on the effect of intrapartum azithromycin on maternal and neonatal infections and deaths.
SEARCH STRATEGY
PubMed, Scopus and Web of Science databases were searched in March 2023.
SELECTION CRITERIA
Randomised controlled trials comparing intrapartum single-dose of azithromycin with placebo.
DATA COLLECTION AND ANALYSIS
Maternal infections, maternal mortality, neonatal sepsis, neonatal mortality. We used the random-effects Mantel-Haenszel method to calculate risk ratios (RR) with 95% confidence intervals (95% CI). We assessed risk of bias of the included studies and estimated the evidence certainty using the GRADE approach.
MAIN RESULTS
After screening 410 abstracts, five studies with 44 190 women and 44 565 neonates were included. The risk of bias was low in four and had some concerns in one of the studies. The risk of endometritis was 1.5% in the azithromycin group and 2.3% in the placebo group (RR 0.64, 95% CI 0.55-0.75), and the evidence certainty was high. The respective risk for chorioamnionitis was 0.05% and 0.1% (RR 0.50, 95% CI 0.22-1.18; evidence certainty moderate). The wound infection rate was lower in the azithromycin group (1.6%) than in the placebo group (2.5%), RR 0.52 (95% CI 0.30-0.89; moderate certainty evidence). The maternal sepsis rate was 1.1% in the azithromycin group and 1.7% in the placebo group (RR 0.66, 95% CI 0.56-0.77; evidence certainty high). Mortality rates did not show evidence of a difference (0.09% versus 0.08%; RR 1.26, 95% CI 0.65-2.42; moderate certainty evidence). The neonatal mortality rate was 0.7% in the azithromycin group and 0.8% in the placebo group (RR 0.94, 95% CI 0.76-1.16; moderate certainty evidence). The neonatal sepsis rate was 7.6% in the azithromycin group and 7.4% in the placebo group (RR 1.02, 95% CI 0.96-1.09; moderate certainty evidence).
CONCLUSIONS
Intrapartum administration of azithromycin to the mother reduces maternal postpartum infections, including sepsis. Impact on maternal mortality remains undecided. Azithromycin does not reduce neonatal sepsis or mortality rates.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Azithromycin; Chorioamnionitis; Neonatal Sepsis; Pregnancy Complications, Infectious; Sepsis; Randomized Controlled Trials as Topic; Peripartum Period
PubMed: 37691261
DOI: 10.1111/1471-0528.17655 -
Vaccine Nov 2023Group B streptococcus (GBS) is a major global cause of neonatal meningitis, sepsis and pneumonia, with an estimated 91,000 infant deaths per year and an additional...
Group B streptococcus (GBS) is a major global cause of neonatal meningitis, sepsis and pneumonia, with an estimated 91,000 infant deaths per year and an additional 46,000 stillbirths. GBS infection in pregnancy is also associated with adverse maternal outcomes and preterm births. As such, the World Health Organization (WHO) prioritised the development of a GBS vaccine suitable for use in pregnant women and use in LMICs, where the burden of disease is highest. Several GBS vaccines are in clinical development. The WHO Defeating Meningitis by 2030 has set a target of 2026 for vaccine licensure. This 'Vaccine Value Profile' (VVP) for GBS is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of pipeline vaccines and vaccine-like products. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships and multi-lateral organizations, and in collaboration with stakeholders from the WHO regions of AFR, AMR, EUR, WPR. All contributors have extensive expertise on various elements of the GBS VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.
Topics: Infant; Infant, Newborn; Pregnancy; Female; Humans; Pregnancy Complications, Infectious; Streptococcal Infections; Streptococcal Vaccines; Streptococcus agalactiae; Meningitis
PubMed: 37951694
DOI: 10.1016/j.vaccine.2023.04.024 -
The Journal of Pediatrics Dec 2023To document the case-fatality rate (CFR) of congenital syphilis diagnosed by molecular tools and rabbit infectivity testing (RIT) of clinical specimens in addition to...
OBJECTIVES
To document the case-fatality rate (CFR) of congenital syphilis diagnosed by molecular tools and rabbit infectivity testing (RIT) of clinical specimens in addition to standard evaluation and to compare that with the CFR using the Centers for Disease Control and Prevention (CDC) surveillance case definition.
STUDY DESIGN
Prospective, single site, cohort study of all cases of syphilis among mothers and their infants from 1984 to 2002. The diagnosis of congenital syphilis was determined using IgM immunoblotting, polymerase chain reaction, and RIT of fetal or infant specimens in addition to clinical, laboratory, and radiographic criteria. Data were retrospectively reviewed to ascertain fetal and neonatal mortality.
RESULTS
During the 18-year study, there were 191 cases of congenital syphilis confirmed by abnormalities on clinical, laboratory, or radiographic evaluation and/or positive serum IgM immunoblot, blood polymerase chain reaction, or blood/cerebrospinal fluid RIT. Of the 191 cases, 59 died for a CFR of 31%. Of the 59 deaths, 53 (90%) were stillborn and 6 (10%) died in the neonatal period. The majority (74%, 39/53) of stillbirths occurred in the third trimester. The CDC surveillance case definition correctly identified all infants with congenital syphilis, but the CDC CFR was 10% which underestimated the CFR by more than 300%.
CONCLUSIONS
Our findings corroborate the high sensitivity of the CDC surveillance definition for congenital syphilis but highlight its poor estimation of its associated mortality. The CFR among infected progeny of pregnant women with syphilis was 31%, due mostly to demise in the third trimester and as such highlights the need for detection and appropriate treatment of syphilis during pregnancy.
Topics: Infant; Animals; Humans; Pregnancy; Female; Rabbits; Syphilis, Congenital; Syphilis; Cohort Studies; Prospective Studies; Retrospective Studies; Pregnancy Complications, Infectious; Immunoglobulin M
PubMed: 37536483
DOI: 10.1016/j.jpeds.2023.113650 -
American Journal of Obstetrics and... Jun 2024
Topics: Humans; Female; Pregnancy; Fetal Blood; COVID-19 Vaccines; Placenta; COVID-19; SARS-CoV-2; RNA, Messenger; Adult; Infectious Disease Transmission, Vertical; Pregnancy Complications, Infectious
PubMed: 38307473
DOI: 10.1016/j.ajog.2024.01.022 -
Journal of Ayub Medical College,... 2023Maternal sepsis is a life-threatening condition with serious adverse feto-maternal outcomes. This descriptive cross-sectional study aimed to study the incidence of...
BACKGROUND
Maternal sepsis is a life-threatening condition with serious adverse feto-maternal outcomes. This descriptive cross-sectional study aimed to study the incidence of common feto-maternal outcomes of maternal sepsis in our hospital.
METHODS
Pregnant females with singleton pregnancy as per inclusion/exclusion criteria were enrolled in the study. A detailed medical history was taken and physical and obstetrical examination was done. They were investigated for the cause of their febrile illness and managed as per department protocols. Data was recorded in a pre-designed pro forma.
RESULTS
The most common cause of infection was UTI (32; 42.6%) followed by genital infections (20; 26.7%) and respiratory tract infections (15; 20%). In 8 (10.7%) patients, the cause couldn't be found. Only one patient developed sepsis and was admitted to the medical ICU. That pregnancy resulted in PROM and an infant with low birth weight was delivered. Both the mother and the child survived and were discharged from the hospital. There was no mortality in our study group.
CONCLUSIONS
Though sepsis was associated with adverse feto-maternal outcomes in our study, the study design prevents us from drawing any conclusions from this study concerning maternal sepsis in our region. Further research is needed to determine the true magnitude of the problem.
Topics: Pregnancy; Infant; Female; Child; Humans; Cross-Sectional Studies; Pregnancy Complications, Infectious; Pregnant Women; Sepsis; Hospitalization; Pre-Eclampsia
PubMed: 38404084
DOI: 10.55519/JAMC-03-12121 -
Journal of Clinical Microbiology Apr 2024Human cytomegalovirus (CMV) is the leading cause of congenital infection worldwide and the most common cause of non-genetic sensorineural hearing loss. As there is no... (Review)
Review
Human cytomegalovirus (CMV) is the leading cause of congenital infection worldwide and the most common cause of non-genetic sensorineural hearing loss. As there is no vaccine or other specific intervention to prevent congenital CMV infection, there is a need to identify maternal and congenital infections with sensitive and specific testing as early as possible. There is no widely accepted practice for screening during pregnancy or in all newborns for identification of possible cases of congenital CMV. Currently, screening during pregnancy is limited to those identified as at risk followed by fetal and/or neonatal testing when congenital infection is suspected. This review focuses primarily on the current status of laboratory testing for diagnosis of maternal and congenital CMV infections. Primary maternal infection is best diagnosed using serologic testing, including CMV IgM, IgG, and avidity testing, while fetal infection should be assessed by nucleic acid amplification testing (NAAT) of amniotic fluid. Urine and saliva NAATs are the mainstay for diagnosis of congenital CMV in the first 3 weeks of life. Testing of dried blood spots can be useful for diagnosis of congenital CMV outside of the newborn period. The gaps in knowledge such as the prognostic value of viral loads in various sample types are addressed.
Topics: Pregnancy; Female; Humans; Infant, Newborn; Cytomegalovirus Infections; Cytomegalovirus; Pregnancy Complications, Infectious; Prognosis; Fetal Diseases
PubMed: 38391188
DOI: 10.1128/jcm.00313-23 -
Placenta Jul 2023The impact of the COVID-19 infection, caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), during the pandemic has been considerably more severe in... (Review)
Review
The impact of the COVID-19 infection, caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), during the pandemic has been considerably more severe in pregnant women than non-pregnant women. Therefore, a review detailing the morphological alterations and physiological changes associated with COVID-19 during pregnancy and the effect that these changes have on the feto-placental unit is of high priority. This knowledge is crucial for these mothers, their babies and clinicians to ensure a healthy life post-pandemic. Hence, we review the placental morphological changes due to COVID-19 to enhance the general understanding of how pregnant mothers, their placentas and unborn children may have been affected by this pandemic. Based on current literature, we deduced that COVID-19 pregnancies were oxygen deficient, which could further result in other pregnancy-related complications like preeclampsia and IUGR. Therefore, we present an up-to-date review of the COVID-19 pathophysiological implications on the placenta, covering the function of the placenta in COVID-19, the effects of this virus on the placenta, its functions and its link to other gestational complications. Furthermore, we highlight the possible effects of COVID-19 therapeutic interventions on pregnant mothers and their unborn children. Based on the literature, we strongly suggest that consistent surveillance for the mothers and infants from COVID-19 pregnancies be prioritised in the future. Though the pandemic is now in the past, its effects are long-term, necessitating the monitoring of clinical manifestations in the near future.
Topics: Female; Pregnancy; Humans; COVID-19; Placenta; SARS-CoV-2; Pregnancy Complications, Infectious; Infectious Disease Transmission, Vertical
PubMed: 37235921
DOI: 10.1016/j.placenta.2023.05.009 -
Nature Communications Aug 2023The effects of heterogeneous infection, vaccination and boosting histories prior to and during pregnancy have not been extensively studied and are likely important for...
The effects of heterogeneous infection, vaccination and boosting histories prior to and during pregnancy have not been extensively studied and are likely important for protection of neonates. We measure levels of spike binding antibodies in 4600 patients and their neonates with different vaccination statuses, with and without history of SARS-CoV-2 infection. We investigate neutralizing antibody activity against different SARS-CoV-2 variant pseudotypes in a subset of 259 patients and determined correlation between IgG levels and variant neutralizing activity. We further study the ability of maternal antibody and neutralizing measurements to predict neutralizing antibody activity in the umbilical cord blood of neonates. In this work, we show SARS-CoV-2 vaccination and boosting, especially in the setting of previous infection, leads to significant increases in antibody levels and neutralizing activity even against the recent omicron BA.1 and BA.5 variants in both pregnant patients and their neonates.
Topics: Infant, Newborn; Female; Pregnancy; Humans; COVID-19; COVID-19 Vaccines; SARS-CoV-2; Vaccination; Antibodies, Neutralizing; Antibodies, Viral; Pregnancy Complications, Infectious
PubMed: 37563124
DOI: 10.1038/s41467-023-39989-y -
Obstetrical & Gynecological Survey May 2024Although the risk of parvovirus B19 infection during pregnancy and subsequent risk of adverse fetal outcome are low, understanding management practices is essential for... (Review)
Review
IMPORTANCE
Although the risk of parvovirus B19 infection during pregnancy and subsequent risk of adverse fetal outcome are low, understanding management practices is essential for proper treatment of fetuses with nonimmune hydrops fetalis. In addition, continued investigation into delivery management, breastfeeding recommendations, and congenital abnormalities associated with pregnancies complicated by parvovirus B19 infection is needed.
OBJECTIVE
This review describes the risks associated with parvovirus B19 infection during pregnancy and the management strategies for fetuses with vertically transmitted infections.
EVIDENCE ACQUISITION
Original articles were obtained from literature search in PubMed, Medline, and OVID; pertinent articles were reviewed.
RESULTS
Parvovirus B19 is a viral infection associated with negative pregnancy outcomes. Up to 50% of people of reproductive age are susceptible to the virus. The incidence of B19 in pregnancy is between 0.61% and 1.24%, and, overall, there is 30% risk of vertical transmission when infection is acquired during pregnancy. Although most pregnancies progress without negative outcomes, viral infection of the fetus may result in severe anemia, congestive heart failure, and hydrops fetalis. In addition, vertical transmission carries a 5% to 10% chance of fetal loss. In pregnancies affected by fetal B19 infection, Doppler examination of the middle cerebral artery peak systolic velocity should be initiated to surveil for fetal anemia. In the case of severe fetal anemia, standard fetal therapy involves an intrauterine transfusion of red blood cells with the goal of raising hematocrit levels to approximately 40% to 50% of total blood volume. One transfusion is usually sufficient, although continued surveillance may indicate the need for subsequent transfusions. There are fewer epidemiologic data concerning neonatal risks of congenital parvovirus, although case reports have shown that fetuses with severe anemia in utero may have persistent anemia, thrombocytopenia, and edema in the neonatal period.
CONCLUSIONS AND RELEVANCE
Parvovirus B19 is a common virus; seropositivity in the geriatric population reportedly reaches 85%. Within the pregnant population, up to 50% of patients have not previously been exposed to the virus and consequently lack protective immunity. Concern for parvovirus B19 infection in pregnancy largely surrounds the consequences of vertical transmission of the virus to the fetus. Should vertical transmission occur, the overall risk of fetal loss is between 5% and 10%. Thus, understanding the incidence, risks, and management strategies of pregnancies complicated by parvovirus B19 is essential to optimizing care and outcomes. Further, there is currently a gap in evidence regarding delivery management, breastfeeding recommendations, and the risks of congenital abnormalities in pregnancies complicated by parvovirus B19. Additional investigations into optimal delivery management, feeding plans, and recommended neonatal surveillance are needed in this cohort of patients.
Topics: Humans; Pregnancy; Female; Infectious Disease Transmission, Vertical; Pregnancy Complications, Infectious; Parvovirus B19, Human; Hydrops Fetalis; Parvoviridae Infections; Erythema Infectiosum; Pregnancy Outcome
PubMed: 38764205
DOI: 10.1097/OGX.0000000000001263