The Info List - Neonatal Infection

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Neonatal infections are infections of the neonate (newborn) during the neonatal period or first four weeks after birth.[1] Neonatal infections may be contracted by transplacental transfer in utero, in the birth canal during delivery (perinatal), or by other means after birth.[2] Some neonatal infections are apparent soon after delivery, while others may develop postpartum within the first week or month. Some infections acquired in the neonatal period do not become apparent until much later such as HIV, hepatitis B and malaria. There is a higher risk of infection for preterm or low birth weight neonates. Respiratory tract infections contracted by preterm neonates may continue into childhood or possibly adulthood with long-term effects that limit one's ability to engage in normal physical activities, decreasing one's quality of life and increasing health care costs. In some instances, neonatal respiratory tract infections may increase one's susceptibility to future respiratory infections and inflammatory responses related to lung disease.[3] Antibiotics
can be effective treatments for neonatal infections, especially when the pathogen is quickly identified. Instead of relying solely on culturing techniques, pathogen identification has improved substantially with advancing technology; however, neonate mortality reduction has not kept pace and remains 20% to 50%.[4] While preterm neonates are at a particularly high risk, full term and post-term infants can also develop infection. Neonatal infection
Neonatal infection
may also be associated with premature rupture of membranes (breakage of the amniotic sac) which substantially increases the risk of neonatal sepsis by allowing passage for bacteria to enter the womb prior to the birth of the infant.[5][6] Neonatal infection
Neonatal infection
can be distressing to the family and it initiates concentrated effort to treat it by clinicians.Research to improve treatment of infections and prophylactic treatment of the mother to avoid infections of the infant is ongoing.


1 Causes

1.1 Bacteria 1.2 Viruses

1.2.1 HIV 1.2.2 Cytomegalovirus 1.2.3 HSV 1.2.4 Zika 1.2.5 Rubella 1.2.6 Other

1.3 Fungi 1.4 Protozoans

2 Risk factors 3 Mechanism

3.1 Pathogenesis

4 Diagnosis

4.1 Viral infection 4.2 Protozoan infection 4.3 Neonatal sepsis

5 Prevention 6 Treatment 7 Epidemiology

7.1 Early-onset infections 7.2 Late onset infections

8 Research 9 See also 10 References 11 Further reading 12 External links

Causes[edit] In industrialized countries, treatment for neonatal infections takes place in the neonatal intensive care unit. The causes and reasons for neonatal infection are many. The origin of infectious bacteria and some other pathogens is often the maternal gastrointestinal and genitourinary tract. Many of the maternal infections with these organisms are asymptomatic in the mother. Other maternal infections that may be transmitted to the infant in utero or during birth are bacterial and viral sexually transmitted infections.[7] The infant's ability to resist infection is complicated by its immature immune system. The causative agents of neonatal infection are bacteria, viruses, and fungi. In addition, the immune system of the neonate may respond in ways that can create problems that complicate treatment, such as the release of inflammatory chemicals. Congenital defects of the immune system also affect the infants ability to fight off the infection.[8][9] Bacteria[edit]

Listeria monocytogenes

Group B streptococcus are typically identified as the cause of the majority of early-onset infections in the neonate.[7][10][11] This pathogen is vertically transmitted (transmitted directly from the mother) to the infant.[12] Enteric bacilli that originate from the digestive system of the mother have become as prevalent as the group B streptococcus pathogens and are currently as likely to cause infection. With the advances in preventing group B streptococcus infections, β-lactam-resistant Escherichia coli
Escherichia coli
infections have increased in causing neonatal deaths in very low birthweight and premature infants.[12] Infections with Staphylococcus aureus
Staphylococcus aureus
are also diagnosed, but not as frequently as group B streptococcus infections.[5] Listeria monocytogenes
Listeria monocytogenes
can also cause infection acquired from tainted food and present in the mother.[4][13] The presence of this pathogen can sometimes be determined by the symptoms that appear as a gastrointestinal illness in the mother. The mother acquires infection from ingesting food that contains animal products such as hot dogs, unpasteurized milk, delicatessen meats, and cheese. Neonatal infection
Neonatal infection
can also occur in term and post-term infants.[14] Infections that develop one month after the birth of the infant are more likely due to Gram-positive bacteria
Gram-positive bacteria
and coagulase positive staphylococci.[15] Acquired maternal infection and subsequent inflammation from Ureaplasma urealyticum is accompanied by a strong immune response and is correlated with the need for prolonged mechanical ventilation.[3][7] Other bacterial pathogens include Streptococcus agalactiae, Streptococcus pyogenes, Viridans streptococci, Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa.[16] Viruses[edit] HIV[edit] Human immunodeficiency virus type I (HIV) infection can occur during labor and delivery, in utero through mother-to-child transmission or postnatally by way of breastfeeding.[17] Transmission can occur during pregnancy, delivery or breastfeeding. Most transmission occurs during delivery. In women with low detectable levels of the virus, the incidence of transmission is lower.[18] Transmission risk can be reduced by:

providing antiretroviral therapy during pregnancy and immediately after birth delivery by caesarean section not breastfeeding antiretroviral prophylaxis in infants born to mothers with HIV.[18]

A low number of women whose HIV
status are unknown until after the birth, do not benefit from interventions that could help lower the risk of mother-to-child HIV
transmission.[19] Cytomegalovirus[edit] Sixty percent of mothers of preterm infants are infected with cytomegalovirus (CMV). Infection
is asymptomatic in most instances but 9% to 12% of postnatally infected low birth weight, preterm infants have severe, sepsis-like infection. CMV infection duration can be long and result in pneumonitis in association with fibrosis. CMV infection in infants has an unexpected effect on the white blood cells of the immune system causing them to prematurely age. This leads to a reduced immune response similar to that found in the elderly.[3] HSV[edit] Herpes simplex virus
Herpes simplex virus
(HSV) can infect the infant during birth. Most women with HVS genital herpes develop asymptomatic infection during pregnancy. HVS inoculation from mother to fetus has a high likelihood of occurring. Mothers who are treated with antiviral prophylaxis are less prone to have an active, symptomatic case at the time of birth. Mothers who have received prophylactic antiviral medication have been shown to be less likely to require a cesarean section. At delivery, mothers treated with antiviral medication are less likely to have a viral shedding at the time of birth.[20] Zika[edit] Zika fever
Zika fever
is caused by a virus that is acquired by the mother and then transmitted to the infant in utero. The CDC is concerned with the potential that this viral infection may cause microcephaly in newborns.[21][22][23] Rubella[edit] Congential rubella is still a risk with higher risk among immigrant women from countries without adequate vaccination programs.[24] Other[edit] Other viral infections such as respiratory syncytial virus (RSV), metapneumovirus (hMPV), rhinovirus, parainfluenza (PIV), and human coronavirus in the neonatal period are associated with recurrent wheezing in later childhood. RSV infections can be prolonged. Premature infants born at less than 32 weeks gestation have more days of cough and wheeze at 1 year of age than those uninfected with RSV.[3] Fungi[edit] In very low birth weight infants (VLBWI), systemic fungus infection is a hospital-acquired infection with serious consequences. The pathogens are usually Candida albicans
Candida albicans
and Candida parapsilosis. A small percentage of fungal infections are caused by Aspergillus, Zygomycetes, Malassezia, and Trichosporon.[25][26] Infection
is usually late-onset. Up to 9% of VLBWI with birth weights of <1,000 g develop these fungus infections leading to sepsis or meningitis. As many as one-third of these infants can die. Candidiasis
is associated with retinopathy, prematurity and negative neurodevelopmental consequences. Candida can colonize the gastrointestinal tract of low birthweight infants (LBI). This gastrointestinal colonization is often a precursor to a more serious invasive infection. The risk of serious candida infection increases when multiple factors are present. These are: thrombocytopenia, the presence of candidal dermatitis, the use of systemic steroids, birth weights of <1,000 g, presence of a central catheter, postponing enteral feeding, vaginal delivery, and the amount of time broad-spectrum antibiotics were given.[26] Protozoans[edit] Infants born with malaria can be infected with a variety of species; Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, and Plasmodium falciparum. In most instances of congenital marlaria is caused by P. vivax and P. falciparum. Women living in areas where malaria is prevalent and common are repeatedly exposed to malaria. In response to maternal infection, mothers develop antimalarial antibodies. It is probable that the antibodies present in the mother offers protection for the baby. Bacterial infection can develop with malaria.[25] Infants that are infected by the protozoan Toxoplasma gondii
Toxoplasma gondii
in utero can be born with chorioretinitis or ocular toxoplasmosis. Globally, it is the most common cause of infections of the back of the eye. (posterior segment). The most common sign is decreased vision in one eye. Other signs and symptoms may appear after the neonatal period and include: miscarriage, stillbirth, chorioretinitis development later in life, intracranial calcification hydrocephalus or central nervous system abnormalities.[27] Risk factors[edit] Risk factors are those conditions which increase the likelihood that an infant will be born with or develop an infection.

Risk factors for neonatal infection within the first week

Factor Notes References

prematurity birth before 40 weeks gestation [8]

meconium aspiration inspiration of stool in utero [14]

Postpartum endometritis inflammation of the uterus after the birth [14]

low birth weight < 40 weeks gestation [8][15]

premature rupture of membranes <12 hours [5][8][15][28]

prolonged premature rupture of membranes >12 hours [5][28]

pre-term onset of labor labor begins before 40 weeks gestation [8][15]

chorioamnionitis inflammation of the fetal membranes(amnion and chorion) due to a bacterial infection [8]

vaginal discharge abnormal discharge can be a result of an infection [8]

tender uterus discomfort when the uterus is examined [29]

rupture of membranes <12 hours [5]

prolonged rupture of membranes >12 hours) [8][29]

in utero infection with pathogens the period of infection allows for the logarithmic growth of pathogens [7]

maternal urinary tract infection bladder and/or kidney infection [8]

prolonged labor


vaginal examinations during labor risk increases with the number of vaginal examinations during labor [8][29]

maternal colonization with group B streptococcus the presence of this bacterium is usually asymptomatic [5][8]

previous baby with early-onset GBS infection


gender males are more susceptible;This risk declines after respiratory distress syndrome is treated [15]

multiples risk is increased for the firstborn [15]

iron supplementation iron is a growth factor for some bacteria [15]

maternal intrapartum fever > 38 °C [8][28]

after insertion of intravenous line may introduce pathogens into the circulation [15]

immature immune system


invasive medical procedures may introduce pathogens into the circulation [15]

hypoxia unexpected resuscitation after birth [15][29]

low socioeconomic status


hypothermia relatively low blood temperature [15]

metabolic acidosis a pH imbalance in the blood [15]

obstetrical complications


prevalence of resistant bacteria in the neonatal intensive care unit nosomial populations [15]

maternal exposure to Toxoplasmosis
gondii a parasite present in cat litter and other animal excrement [27]

Risk factors for late onset for neonatal infection >one week after birth

Factor Notes References

after insertion of an intravenous line hypothermia

poor feeding


more likely to develop osteoarthritis

soft tissue infection

meningitits [15]

resides in endemic malaria area [25]

The risk for developing catheter-related infections is offset by the increased survival rate of premature infants that have early onset sepsis. Intravenous administration of prophylactic immunoglobin enhances immunity of the immature infant and is used for treatment.[15] Mechanism[edit]


accompanies infection and is likely to complicate treatment and recovery. Inflammation
is linked to reduced growth of the lungs of the premature baby.[3] Pathogenesis[edit] The recent identification of the presence of microorganisms in maternal-infant body fluids that were previously thought to be sterile has provided one explanation for the presence of the inflammatory response in both the mother and infant. Sixty-one percent of pregnant women with chorioamnionitis, or inflammation of the amniotic fluid, were found to be infected by microorganisms. Often, more than one pathogen was present. In fifteen percent of pregnant women inflammation was still evident even though there was no evidence of pathogens. This may indicate that there are other causes. A high percentage, 51% to 62%, of pregnant women who had chorioamnionitis also had inflammation of the placenta.[3] Diagnosis[edit] Diagnosis
of infection is based upon the recovery of the pathogen or pathogens from the typically sterile sites in the mother or the baby. Unfortunately, as many half of pregnant women are asymptomatic with a gonorrhea infection and other sexually transmitted infections.[30][31][32] Samples are obtained from urine, blood or cerebrospinal fluid. Diagnosis
of infection can also be aided by the use of more nonspecific tests such as determining the total white blood cell count, cytokine levels and other blood tests and signs.[15]

Signs of infection Notes References

abnormal complete blood count looking for signs of infection in the blood: increased white cell count; presence of immature neutrophils [5][29]

increased C-reactive protein a chemical in the blood that shows that the baby's immune system is actively reacting to infection [5][29][33]

accessory muscle use using the intercostal muscles to assist in breathing [29]

tachycardia a heart rate that is faster than normal [5]

bradycardia a heart rate that is slower than normal [5]

chest recession


respiratory distress the baby has trouble breathing [5][29]

nasal flaring the baby's nostrils expand when it inhales [29]

expiratory grunt a sound of effort when the baby exhales [29][34]

apnea the baby stops breathing [5][29]



positive urine culture


positive cerebral spinal fluid


other positive cultures from eyes, ear canal, umbilicus axilla anus [5]

lethargy the baby seems tired and has slow or no movements [5][29]

hypotonia the muscles seem flabby and weak [5][29]



irritability infant appears uncomfortable and has difficulty being soothed [5][29]

weak cry




poor perfusion poor circulation [5][29]

hypotension low blood pressure [29]

acidosis pH imbalance in the blood [5][29]

diarrhea water-like, unformed stools [29]

poor feeding


oxygen requirement


bulging fontanel the soft spot on the head is bulging [29]





disseminated intravascular coagulation widespread clotting of blood [29]

renal failure kidneys do not function [29]

bacteremia bacteria cultured from the blood of the newborn [5]

Viral infection[edit] Symptoms and the isolation of the virus pathogen the upper respiratory tract is diagnostic. Virus identification is specific immunologic methods and PCR. The presence of the virus can be rapidly confirmed by the detection of the virus antigen. The methods and materials used for identifying the RSV virus has a specificity and sensitivity approaching 85% to 95%. Not all studies confirm this sensitivity. Antigen detection has comparatively lower sensitivity rates that approach 65% to 75%.[35] Protozoan infection[edit] Congential malaria has its own set of signs:

Signs of congenital malaria infection Notes References

splenomegaly enlarged speen




poor feeding

hepatomegaly enlarged liver

failure to thrive

loose stools



central nervous system infection

splenic rupture

renal failure

blackwater fever infection with P. falciparum only [25]

Neonatal sepsis[edit] Main article: Neonatal sepsis Neonatal sepsis of the newborn is an infection that has spread through the entire body. The inflammatory response to this systematic infection can be as serious as the infection itself.[3] In infants that weigh under 1500 g, sepsis is the most common cause of death. Three to four percent of infants per 1000 births contract sepsis. The mortality rate from sepsis is near 25%.[4] Infected sepsis in an infant can be identified by culturing the blood and spinal fluid and if suspected, intravenous antibiotics are usually started. Lumbar puncture is controversial because in some cases it has found not to be necessary while concurrently, without it estimates of missing up to one third of infants with meningitis is predicted.[15] Prevention[edit] To reduce neonatal infection, routine screening of pregnant women for HIV, hepatitis B, syphilis, and rubella susceptibility is required in the UK.[36] Treatment with an vaginal antibiotic wash prior to birth does not prevent infection with group B streptococcus bacteria.[5][37] Breast milk protects against necrotizing enterocolitis.[8] Because GBS bacteria can colonize the lower reproductive tract of 30% of women, typically pregnant women are tested for this pathogen from 35 to 37 weeks of pregnancy. Before delivery treatment of the mother with antibiotics reduces the rate of neonatal infection.[5] Prevention of the infection of the baby is done by treating the mother with penicillin. Since the adoption of this prophylatic treatment, infant mortality from GBS infection has decreased by 80%.[4] Mothers with symptomatic HSV and who are treated with antiviral prophylaxis are less prone to have an active, symptomatic case at the time of birth and it may be able to reduce the risk of passing on HSV during birth. Cesarean delivery reduces the risk of infection of the infant.[20] Treatment[edit] Neonatal infection
Neonatal infection
treatment is typically started before the diagnosis of the cause can be confirmed. Neonatal infection
Neonatal infection
can be prophylactically treated with antibiotics.[7] Maternal treatment with antibiotics is primarily used to protect against group B streptococcus.[15] Women with a history of HSV, can be treated with antiviral drugs to prevent symptomatic lesions and viral shedding that could infect the infant at birth. The antiviral medications used include acyclovir, penciclovir, valacyclovir, and famciclovir. Only very small amounts of the drug can be detected in the fetus. There are no increases in drug-related abnormalities in the infant that could be attributed to acyclovir. Long-term effects of antiviral medications have not been evaluated for their effects after growth and development of the child occurs. Neutropenia
can be a complication of acyclovir treatment of neonatal HSV infection, but is usually transient.[20] Treatment with immunoglobulin therapy has not been proven to be effective.[38]

Epidemiology[edit] Up to 3.3 million newborns die each year and 23.4% of these die of neonatal infection. About half of the deaths caused by sepsis or pneumonia happen in the first week postpartum. In industrialized countries, prophylactic antibiotic treatment of the mothers identified with group B streptococcus, early identification of sepsis in the newborn, and administration of antibiotics to the newborn has reduced mortality.[5] Neonatal herpes in North America is estimated to be from 5 – 80 per 100,000 live births. HSV has a lower prevalence in mothers outside the United States. In the United Kingdom the incidence is much lower and estimated to be 1.6 per 100,000 live births. Approximately 70% to 80% of infected infants are born to mothers with no reported history of HSV infection.[20] Regions with low neonatal mortality include Europe, the Western Pacific, and the Americas, which have sepsis rates that account for 9.1% to 15.3% of the total neonatal deaths worldwide. This is in contrast with the 22.5 to 27.2% percentage of total deaths in resource-poor countries such as Nigeria, the Democratic Republic of the Congo, India, Pakistan, and China.[5] In the UK, the proportions of pregnant women who are newly screened positive for hepatitis B, syphilis, and HIV
have remained constant since 2010 at about 0.4%, 0.14% and 0.15%, respectively. Estimated prevalence levels among pregnant women for hepatitis B and HIV, including previous diagnoses, were higher at 0.67% and 0.27%. Pregnant women evaluated as susceptible to rubella due to low antibody levels have increased by over 60%, to about 7.2%. However, this increase is probably due to changes in testing methods and evaluation criteria.[39] In North America, prior to the 1950s, group A β-hemolytic streptococcus (GAS) was the most common pathogen associated with neonatal sepsis prior to the 1960s. In the past twenty years, the most common pathogen causing sepsis is coagulase-negative staphylococci that exist as biofilms associated with infected central venous or arterial catheters.[7] Infections can be fatal and contribute to long-term morbidity and disability among the infants who survive into childhood.[7] Neonatal sepsis effects 128 cases per 1000 live births. Meningitis can occur in the septic infant.[15] Expectant mothers with HVS have a 75% chance of at least one flare-up during their pregnancy.[20] In limited studies it was found that infants in Africa born to mothers with malaria have a 7% of acquiring congenital malaria.[25] Early-onset infections[edit] Early onset sepsis can occur in the first week of life. It usually is apparent on the first day after birth. This type of infection is usually acquired before the birth of the infant. Premature rupture of membranes and other obstetrical complications can add to the risk of early-onset sepsis. If the amniotic membrane has been ruptured greater than 18 hours before delivery the infant may be at more risk for this complication. Prematurity, low birth weight, chorioamnionitis, maternal urinary tract infection and/or maternal fever are complications that increase the risk for early-onset sepsis. Early onset sepsis is indicated by serious respiratory symptoms. The infant usually suffers from pneumonia, hypothermia, or shock. The mortality rate is 30 to 50%.[15] Late onset infections[edit] Infections that occur after the first week of life but before the age of 30 days are considered late onset infections. Obstetrical and maternal complications are not typically the cause of these late onset infections; they are usually acquired by the infant in the hospital neonatal intensive care unit. The widespread use of broad-spectrum antibiotics in the nursery intensive care unit can cause a higher prevalence of invasive antibiotic resistant bacteria.[15] Meconium aspiration syndrome has a mortality rate just over 4%. This accounts for 2% for all neonatal deaths.[14] Research[edit] The susceptibility to risk of infection and immune deficiencies are active areas of research. Studies regarding the role of viruses in neonatal infections are lacking. Research also continues into the role and protective effect of gut, skin and other human microbiomes and the colonization during the neonatal period.[3][15] The comparison between resource rich countries and resource poor countries makes it somewhat difficult to compare the diagnosis success since industrialized regions are able to confirm the diagnosis and presence of pathogens in the clinical laboratory. Clinical testing may not be available in all settings and clinicians must rely on the signs of infection in the newborn. Research data from Africa and Southeast Asia is scarce.[5] The result of some research has been the identification of diagnostic tools and procedures that could identify mothers with group B streptococcus infection in resource-poor regions. These procedures would be easy and inexpensive to use. Those mothers who are identified as being infected could then be prophylactly treated prior to the birth of the baby.[5] Probiotic administration of Lactobacillus species has shown some success.[16] A GBS vaccine is currently being tested but not currently available. Vaccination is estimated to being able to prevent 4% of GBS infections for preterm births and 60–70% for neonatal GBS infections in the US. The projected benefits of maternal vaccination is the prevention of 899 cases of GBS disease and 35 deaths among infants. The cost savings in the prevention of GBS may be over 43 million dollars. Vaccination may be especially beneficial in low to middle income countries where screening and prophylactic treatment is not possible. Analysts project that GBS vaccination would prevent 30–54% of infant GBS cases. Screening, prophylactic antibiotics and vaccine would prevent 48% of infection.[40] See also[edit]

Preterm birth


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determination in predicting chorioamnionitis and neonatal infection in pregnant women with premature rupture of membranes: A systematic review". European Journal of Obstetrics & Gynecology and Reproductive Biology. 147 (2): 124–129. doi:10.1016/j.ejogrb.2009.09.017. ISSN 0301-2115.  ^ https://www.gpnotebook.co.uk/simplepage.cfm?ID=-328531926 ;subscription required ^ Mayhall, C (2012). Hospital epidemiology and infection control. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-1-60831-300-6; Access provided by the University of Pittsburgh.  ^ "Infectious diseases in pregnancy screening: programme overview; Detailed guidance". GOV.UK. 1 January 2015. Retrieved 2016-01-07.  ^ Ohlsson, Arne; Shah, Vibhuti S; Stade, Brenda C; Ohlsson, Arne (2014). "Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection". Reviews. 12: CD003520. doi:10.1002/14651858.CD003520.pub3. PMID 25504106.  ^ Ohlsson, Arne; Lacy, Janet B; Ohlsson, Arne (2015). "Intravenous immunoglobulin for suspected or proven infection in neonates". Reviews. doi:10.1002/14651858.CD001239.pub5.  ^ Infection
reports; HIV
– STIs Antenatal screening for infectious diseases in England: summary report for 2014 (PDF). Infection
reports Volume 9 Number 43 Published on: 4 December 2015 HIV
– STIs Antenatal screening for infectious diseases in England: summary report for 2014 (Report). 9. Public Health England. 4 December 2015. Retrieved 8 January 2016.  ^ Cortese, Francesca; Scicchitano, Pietro; Gesualdo, Michele; Filaninno, Antonella; De Giorgi, Elsa; Schettini, Federico; Laforgia, Nicola; Ciccone, Marco Matteo (2015). "Early and Late Infections in Newborns: Where Do We Stand? A Review". Pediatrics
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Further reading[edit]

Jenster, Meike; Bonifacio, Sonia L.; Ruel, Theodore; Rogers, Elizabeth E.; Tam, Emily W.; Partridge, John Colin; Barkovich, A. James; Ferriero, Donna M.; Glass, Hannah C. (2014-07-01). "Maternal or neonatal infection: association with neonatal encephalopathy outcomes". Pediatric research. 76 (1): 93–99. doi:10.1038/pr.2014.47. ISSN 0031-3998. PMC 4062582 . PMID 24713817.  "National Guideline Clearinghouse Antibiotics
for early-onset neonatal infection. Antibiotics
for the prevention and treatment of early-onset neonatal infection". www.guideline.gov. Retrieved 2016-01-15. 

External links[edit]

"WHO Newborn death and illness". www.who.int. Retrieved 2016-01-15. 

v t e

Certain conditions originating in the perinatal period / fetal disease (P, 760–779)

Maternal factors and complications of pregnancy, labour and delivery


praevia Placental insufficiency Twin-to-twin transfusion syndrome



umbilical cord:

Umbilical cord prolapse Nuchal cord Single umbilical artery

Length of gestation and fetal growth

Small for gestational age/Large for gestational age Preterm birth/Postmature birth Intrauterine growth restriction

Birth trauma


Cephalhematoma Chignon Caput succedaneum Subgaleal hemorrhage

Brachial plexus lesion

Erb's palsy Klumpke paralysis

By system


Intrauterine hypoxia Infant
respiratory distress syndrome Transient tachypnea of the newborn Meconium
aspiration syndrome pleural disease

Pneumothorax Pneumomediastinum

Wilson–Mikity syndrome Bronchopulmonary dysplasia


Pneumopericardium Persistent fetal circulation

Haemorrhagic and hematologic disease

Vitamin K deficiency

Haemorrhagic disease of the newborn


ABO Anti-Kell Rh c Rh D Rh E

Hydrops fetalis Hyperbilirubinemia

Kernicterus Neonatal jaundice

Velamentous cord insertion Intraventricular hemorrhage

Germinal matrix hemorrhage

Anemia of prematurity


Ileus Necrotizing enterocolitis Meconium

Integument and thermoregulation

Erythema toxicum Sclerema neonatorum

Nervous system

asphyxia Periventricular leukomalacia


Gray baby syndrome muscle tone

Congenital hypertonia Congenital hypotonia


Vertically transmitted infection Neonatal infection

Congenital rubella syndrome Neonatal herpes simplex Mycoplasma hominis infection Ureaplasma urealyticum infection

Omphalitis Neonatal sepsis

Group B streptococcal infection

Neonatal conjunctivitis


Miscarriage Perinatal

Stillbirth Infant

Neonatal withdrawal

v t e

Vertically transmitted infections (P35–P39, 771)



Congenital rubella syndrome Congenital cytomegalovirus infection Neonatal herpes simplex Hepatitis B Congenital varicella syndrome HIV Fifth disease


Congenital syphilis



transplacental TORCH complex

During birth

transcervical Candidiasis Gonorrhea Listeriosis

Late pregnancy

Listeriosis Congenital cytomegalovirus infection

By breastfeeding