Perinatal infection screening and prevention

Overview & Definition

Picture the handover at a busy birth. A term infant has just arrived and the midwife mentions the mother is "GBS positive, two doses of penicillin given". Before you examine the baby, you have already started preventing disease. That handover — a screen result turned into an intervention — is the whole of this topic. [3]

A perinatal infection is any infection transmitted from the mother to the fetus or newborn around the time of birth — through the placenta, up the genital tract, across the birth canal, or in breast milk. The catalogue is long, from Group B Streptococcus to cytomegalovirus to syphilis, but the paediatric question is always the same: was the mother screened, was the result acted on, and what does the baby need now? [1] [3]

Two ideas run through everything that follows. First, vertical transmission is usually preventable, and the interventions that prevent it — maternal treatment, intrapartum antibiotics, neonatal prophylaxis and immunisation — are cheap, old and effective. [6] [9] Second, the screen is only useful if it changes management. A positive GBS swab changes nothing for the mother at the booking visit; it only matters once labour begins. So the discipline of perinatal infection care is not running tests but closing the loop from result to action, for every mother, every time. [3]

References15Show ledgerHide ledger

1. [1]Schrag SJ Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. New England Journal of Medicine, 2000.PMID 10620644
2. [2]Russell NJ Maternal Colonization With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses. Clinical Infectious Diseases, 2017.PMID 29117327
3. [3]Verani JR Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recommendations and Reports, 2010.PMID 21088663
4. [4]Ohlsson A Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database of Systematic Reviews, 2014.PMID 24915629
5. [5]Stoll BJ Early-Onset Neonatal Sepsis 2015 to 2017, the Rise of Escherichia coli, and the Need for Novel Prevention Strategies. JAMA Pediatrics, 2020.PMID 32364598
6. [6]Connor EM Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. New England Journal of Medicine, 1994.PMID 7935654
7. [7]Violari A Early antiretroviral therapy and mortality among HIV-infected infants. New England Journal of Medicine, 2008.PMID 19020325
8. [8]Coovadia HM Efficacy and safety of an extended nevirapine regimen in infant children of breastfeeding mothers with HIV-1 infection for prevention of postnatal HIV-1 transmission (HPTN 046): a randomised, double-blind, placebo-controlled trial. Lancet, 2012.PMID 22196945
9. [9]Schillie S Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations and Reports, 2018.PMID 29939980
10. [10]Gomez GB Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. Bulletin of the World Health Organization, 2013.PMID 23476094
11. [11]Best JM Rubella. Seminars in Fetal & Neonatal Medicine, 2007.PMID 17337363
12. [12]Kenneson A Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Reviews in Medical Virology, 2007.PMID 17579921
13. [13]Kimberlin DW Valganciclovir for symptomatic congenital cytomegalovirus disease. New England Journal of Medicine, 2015.PMID 25738669
14. [14]Corey L Maternal and neonatal herpes simplex virus infections. New England Journal of Medicine, 2009.PMID 19797284
15. [15]Mandelbrot L Prenatal therapy with pyrimethamine + sulfadiazine vs spiramycin to reduce placental transmission of toxoplasmosis: a multicenter, randomized trial. American Journal of Obstetrics and Gynecology, 2018.PMID 29870736