DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
RECOGNITION AND ASSESSMENT
Brain
- Intracranial calcifications
- Microcephaly
- Hydrocephaly
- Seizures
Blood
- Disseminated intravascular coagulation
- Cytopenias
- Bleeding
- Lymphadenopathy
Skin
- Vesicular or bullous lesions
- Pustular or scarring lesions
- Petechiae or purpura
- Condylomata lata
- Desquamation (hands and feet)
In-utero
- Intrauterine growth restriction
- Oligo -or polyhydramnios
- Hydrops
Eyes and ENT
- Microphthalmia
- Congenital cataracts
- Chorioretinitis or keratitis
- Sensorineural hearing loss or failed newborn hearing screen
- Haemorrhagic rhinitis
- Saddle nose
Skeletal
- Bony abnormalities
- Limb malformations
System involvement
- Sepsis
- Myocarditis
- Congenital cardiac anomalies
- Congenital glomerulonephritis
Liver
- Hepatitis
- Hepato- or splenomegaly
- Jaundice
- Ascites
INVESTIGATIONS
- If history of foreign travel in pregnancy, discuss with paediatric infectious diseases
Table 1
Clinical scenario | S | C | O | R | T | C | H | ||||
Parvo-virus B19 | Entero-virus | Other | VZV | HSV | HIV | Hepatitis B/C | |||||
Abnormal brain development | ✓ | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | ✓ | - | - |
Sepsis | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | ✓ | - | - | |
Petechiae/purpura, extramedullary haematopoiesis | ✓ | ✓ | ✓ | - | - | ✓ | ✓ | ✓ | ✓ | - | - |
Blisters | ✓ | ✓ | - | - | - | ✓ | ✓ | ✓ | - | - | |
Intrauterine growth restriction | ✓ | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | - |
Abnormal antenatal scans* | ✓ | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | - |
Eye disease | ✓ | ✓ | - | - | ✓ | ✓ | ✓ | ✓ | ✓ | - | - |
Hearing loss | ✓ | ✓ | - | - | ✓ | ✓ | ✓ | ✓ | ✓ | - | - |
Limb abnormalities | ✓ | - | - | - | ✓ | ✓ | ✓ | - | - | - | |
Cardiac abnormalities | ✓ | - | - | ✓ | ✓ | ✓ | - | - | - | - | |
Liver abnormalities | ✓ | ✓ | - | ✓ | - | ✓ | ✓ | - | ✓ | - | - |
No antenatal booking bloods** | - | - | - | - | - | - | - | - | - | ✓ | ✓ |
* Periventricular calcification, hyperechogenic bowel, ventriculomegaly, microcephaly, fetal growth restriction, hydrops
** URGENT sample required: HIV, syphilis (paired – not cord blood), hepatitis B serology
Key
S | Syphilis |
C | Cytomegalovirus |
O | Other |
R | Rubella |
T | Toxoplasmosis |
C | Chicken pox |
H | Herpes simplex and other blood borne viruses |
Specific investigations
- Send placental samples for histopathology and microbiology/virology stating ‘suspected congenital infection’
Syphilis
- See Syphilis – babies born to mothers with positive serology guideline for investigations and management
CMV
- See CMV guideline for investigations and management
Other
Parvovirus B19
- PCR: blood
Enterovirus
- PCR: blood, NPA/nasal secretions, skin lesions if appropriate
Rubella
- PCR: blood and saliva
- Audiology and ophthalmology review
Toxoplasmosis
- Paired maternal/infant serology (not cord blood)
- Add serology to booking bloods
- PCR: neonatal blood, placenta
- Placental microscopy
- Cranial US +/- MRI head
- Audiology and ophthalmology review
Chickenpox (VZV)
- See Fetal varicella syndrome section of Varicella guideline
HSV, HIV, Hepatitis, HTLV-1
- See Herpes simplex virus (HSV), Human immunodeficiency virus (HIV) and Hepatitis B and C guidelines
If high clinical suspicion or positive results refer to paediatric infectious diseases