Treatment for Congenital Infections

As far as treatment … I should go back. I realize I didn’t say anything about treatment with CMV and the babies with congenital CMV; you would like to treat them and with recent successes with toxoplasmosis it makes this more likely. A better idea. However a national study using ganciclovir failed to show benefit. Having said that, any severe baby with CMV I would treat with ganciclovir.

Coming back to varicella infection; there is no data on treatment if they have any evidence of activity, which you don’t usually see, that I would treat these babies with acyclovir.

The second aspect is infection near term and the risk period is very clear and it’s at a time when the mother is infected and the baby gets infected in utero but gets no antibody. This period is five days or less before delivery, or two days after delivery. These babies will have a congenital infection and will have an illness that looks like smallpox. That is the lesions come all at once, and the mortality, untreated, is very high; 30%. So any babies with these criteria should receive varicella zoster immune globulin at birth. They shouldn’t get prophylactic acyclovir, but as soon as any symptoms develop, they should be treated with acyclovir.
The next are enteroviruses and again enterovirus infections are exceedingly common in pregnant women in the summer. Fortunately, even though infection probably gets to the fetus, the majority of these are not a problem. However, infections in the last two weeks percentage-wise, most are mild but can lead at birth to severe meningoencephalitis and myocarditis and sepsis-like illness, with hepatitis and disseminated intravascular coagulation. The diagnosis again for enteroviruses is culture and now PCR of CSF and actually now PCR can be done on stool, throat and urine specimens as well.

Treatment; there is no specific treatment. In nursery outbreaks that end in severe disease, giving IVIG makes sense, although there is little evidence of benefit. Lastly there is a new drug, not licensed yet, called proconerol which is in trial for neonatal infection but has been shown to be effective in older patients with meningitis.

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