Paeds · fetal-neonatal-and-perinatal
Perinatal infection screening and prevention
Also known as Group B Streptococcus (GBS) screening · Intrapartum antibiotic prophylaxis · Mother-to-child transmission (MTCT) · Congenital infection prevention · TORCH screening · Vertical transmission prevention
Fellowship guide to preventing mother-to-child infection: the universal antenatal screen (HIV, hepatitis B, syphilis, rubella), Group B Streptococcus screening and intrapartum prophylaxis, hepatitis B and HIV neonatal prophylaxis, and the assessment of the exposed or unwell neonate.
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Target exams
Red flags
- Neonatal respiratory distress, grunting, tachypnoea or apnoea in the first 72 hours — think early-onset GBS sepsis
- Maternal HIV with detectable viral load at delivery, or unknown / late-presenting status
- Hepatitis B surface antigen positive mother, or HBV status unknown at birth
- Untreated or partially treated maternal syphilis — risk of stillbirth, hydrops and congenital syphilis
- Maternal primary genital herpes near the time of delivery — highest neonatal HSV risk
- Petechiae, hepatosplenomegaly, jaundice, chorioretinitis or microcephaly at birth — stigmata of congenital infection
- Maternal fever in labour with fetal tachycardia — possible chorioamnionitis
Life stages
Care settings
Clinical exam formats
Board mappings
- Neonatal and Perinatal Medicine
- General and Community Paediatrics
- Current 2026 PREP curriculum — Learning Objective 1.1.2: Assess and manage the newborn infant with perinatal infection risk factors
- Current 2026 PREP curriculum — Learning Objective 2.1.4: Apply prevention and screening strategies for perinatal and congenital infection
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 11: Acute care and procedures
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
- Medical Sciences
- Long Cases
- Short Cases
- 1. Neonatal medicine: Prevention, recognition and management of perinatal and congenital infection
- 4. Professional skills and knowledge: Patient management
- 5. Early detection and management of acutely ill children
- 7. Patient safety, including safe prescribing and infection prevention
- Foundation of Practice (FOP)
- Theory and Science (TAS)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- General Pediatrics Content Outline — Domain 2: Fetal and Neonatal Care
- General Pediatrics Content Outline — Domain 9: Infectious Diseases
- General Pediatrics Content Outline — Universal Task 1: Physiology and Pathophysiology
- General Pediatrics Content Outline — Universal Task 3: Diagnosis
- Patient Care 3: Organize and Prioritize Patient Care
- Patient Care 4: Clinical Reasoning
- Patient Care 5: Patient Management
- Medical Knowledge 1: Core signs and symptoms of disease
- Medical Expert
- Neonatal-Perinatal Medicine
- Pediatrics: Foundations EPA #1 — Recognizing deteriorating and/or critically ill patients and initiating stabilization and management
- Pediatrics: Foundations EPA #4 — Providing care to a healthy newborn
Two different babies, two different problems
Early-onset GBS sepsis
Hepatitis B exposed but protected
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]
References15ShowHide
- [1]Schrag SJ Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. New England Journal of Medicine, 2000.PMID 10620644
- [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]Verani JR Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recommendations and Reports, 2010.PMID 21088663
- [4]Ohlsson A Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database of Systematic Reviews, 2014.PMID 24915629
- [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]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]Violari A Early antiretroviral therapy and mortality among HIV-infected infants. New England Journal of Medicine, 2008.PMID 19020325
- [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]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]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]Best JM Rubella. Seminars in Fetal & Neonatal Medicine, 2007.PMID 17337363
- [12]Kenneson A Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Reviews in Medical Virology, 2007.PMID 17579921
- [13]Kimberlin DW Valganciclovir for symptomatic congenital cytomegalovirus disease. New England Journal of Medicine, 2015.PMID 25738669
- [14]Corey L Maternal and neonatal herpes simplex virus infections. New England Journal of Medicine, 2009.PMID 19797284
- [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