Iowa Neonatology Handbook: Infection

Congenital Infections

Charles Grose, MD and Herman A. Hein MD
Peer Review Status: Internally Peer Reviewed

1. Congenital Infections
   
   The infant suspected of being infected with syphilis, rubella, herpesviruses (HSV, VZV, CMV), HIV or other agents, particularly the enteroviruses, represents a risk to other infants and hospital personnel, particularly pregnant women. Because it is not possible to isolate all newborns who might have one of these congenital infections, the purpose of these policies is to minimize the risk of nosocomial transmission.
   
2. Rubella Immunity
   
   All personnel working in the 4 West Nurseries, both male and female, must be immune to rubella (see personnel policy).
   
3. Precautions
   
   1. The infant with known or suspected infection or with known or strongly suspected congenital syphilis, rubella, or enterovirus infection should be placed in strict isolation. If the clinical condition allows (see separate policy for Herpes simplex infections), the infant may be placed in strict isolation with his mother. Pregnant women should not have contact with these infants and a notice to this effect should be posted at the entrance to the room.
      
   2. The infant suspected of possibly having a congenital syphilis, rubella or enterovirus may be segregated within an incubator or admitted to an isolation room and placed on excretion-secretion precautions. Pregnant women should not have contact with these infants. The incubator or heater bed should have a secretions precautions label affixed and a label prominently posted stating that no pregnant women should have contact with this patient.
      
   3. The requirements for isolation or segregation for other viral or bacterial pathogens can be found in the Hospital Isolation Manual.
      
4. Universal Precautions:
   
   Universal infection precautions should be used with all infants. Those include wearing gloves when performing invasive procedures (such as drawing blood or starting IVs) or when handling a newly born infant who has not been bathed for the first time. A mask, gloves and goggles (or eyeglasses) should be worn when performing procedures where blood may be propelled or splashed into the eyes (such as insertion of arterial catheters).
   
5. HIV Infection:
   
   While congenital HIV infection is an uncommon disease in Iowa, knowledge about caring for these infants is very important. Vertical transmissions from an infected mother to her child is the cause of over 90% of AIDS cases in children; it has become the primary cause of new cases as other modes of transmission have been eliminated, e.g., transfusion of contaminated blood products.
   
   The perinatal transmission rate is estimated to be 13-39%. Intrauterine, intrapartum, and postpartum infections contribute to this perinatal transmission rate, which is reduced by approximately two-thirds with zidovudine therapy of seropositive pregnant women and their newborns. The newborn therapy involves 6 weeks of oral zidovudine.
   
   Breastfeeding by sero-positive mothers is contraindicated in the U.S. where safe, alternative sources of feeding are available. HIV has been detected in breast milk and transmission of HIV by this route has been demonstrated.
   
   When a baby is born to an HIV seropositive mother, the nursery health care personnel should always wear gloves when handling the newborn infant. If possible, the baby should room in with the mother. Diagnosis and testing of a newborn infant of a seropositive mother should include an infectious disease physician consultation as they will play an active role in the infant’s follow-up. Testing of newborn infants by virologic tests, initially with PCR or culture is recommended at 1 month of age and then between 4 and 6 months of age with subsequent serologic testing and the initiation of antiretroviral therapy if and when indicated.
   
   Coinfection with other bacteria or viruses is possible e.g., CMV and excretion-secretion precautions are indicated.

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