|Reviewed by Dr Liz Wilson and Dr MC Croxson|
Infection of the fetus can result in embryonic death, stillbirth, prematurity, intrauterine growth retardation, developmental abnormalities or congenital disease.
Clinical findings are rarely disease specific but include:
The combination of IUGR with any of these features should prompt
investigation for congenital infection. The mother’s antenatal (“booking” and/or
later) bloods should be checked, including HIV status. Maternal and infant serum
should be obtained for toxoplasma, CMV and syphilis serology (see appropriate
sections) and infant urine sent for CMV culture. Serology for parvovirus B19
(more commonly a cause of hydrops), HIV, herpes and VZV may also be required
according to clinical history and examination.
This guideline clarifies the local practice for investigation as a recent review (de Jong 2013) highlighted several potential problems with “Torch testing”.
See also: Hepatitis C and HIV
N.B. even if amniocentesis has been performed with positive toxoplasmosis PCR confirmation of infection in the baby should be sought.
- Cord blood - label clearly 'cord blood'.
- Placenta - Multiple small (<20g) samples taken from various sites around the placenta – mainly from fetal side near umbilical cord): place aseptically in sterile disposable plastic container. Keep chilled. For toxoplasma PCR.
- Placenta also should be sent for histology.
- Amniotic fluid - collect where available as this may be very informative - 10ml in sterile plastic container for toxoplasma PCR.
- Newborn serum - 1ml plain blood (red top) for toxoplasma IgG and IgM. Label clearly 'newborn serum - not cord blood' and request endpoint titre for IgG, see below.
- Maternal serum for toxoplasma IgG and IgM
The newborn blood and maternal blood will allow direct comparison of maternal and fetal antibody levels, i.e, is there any evidence of fetal infection as revealed by fetal antibody production? Cord blood is proving unreliable for antibody titration. Please request end point titre so that if level is >200 I.U./ml the lab will dilute the serum further. The lab must be telephoned with this request as it is not standard practice.
All these samples should be sent to:
Department of Virology & Immunology
Level 2, Building 31
- Maternal serum for toxoplasma IgG (end point titre, see above) avidity, and IgM.
- Infant serum (red top) for toxoplasma IgG (end point titre, see above) and IgM; and infant blood (CPD or EDTA tube) for toxoplasma PCR
- Head ultrasound
- CSF for M, C and S, protein, glucose and toxoplasma PCR : please discuss case first with paediatric infectious diseases team as this may not be required if low risk
- Ophthalmology review
- Refer to Paediatric Infectious Diseases Team for treatment and follow up and ensure mother’s NHI and relevant results are included in the referral.
Long term: serial audiology and developmental assessment, head circumference, ophthalmology. Click here to link to: Nursing Care of Infants who are CMV positive
The recommendations for treatment of congenital CMV are evolving: please consult the paediatric infectious disease team.
Evaluation of newborn for syphilis is indicated if:
Or if any of the following clinical features present:
The above are relatively specific for congenital syphilis, compared with other nonspecific signs of congenital infection:
Refer to Paediatric Infectious Disease Team for treatment advice and follow up. Please ensure full information on the mother’s serology and treatment is included in the referral and provide her NHI number.
Symptomatic babies require treatment as soon as possible after investigations are complete, with 10 day course of benzyl penicillin.
Gloves should be worn for handling babies with suspected congenital syphilis
as moist open lesionsof skin and mucous membranes, secretions and possibly blood
are contagious until 24hrs of penicillin treatment has been completed
|1||de Jong EP, Vossen AC, Walther FJ, Lopriore E. How to use neonatal TORCH testing. Arch Dis Child Educ Pract Ed. 2013 Jun;98(3):93-8.|