Affiliation:
1. Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi,” Ponderano, Italy
2. Department of Surgical Sciences, University of Turin, Turin, Italy
3. Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy
4. Department of Gynecology and Obstetrics, Hopital Beauregard, AUSL Valleè d'Aoste, Aosta, Italy
Abstract
Neonatal infections are responsible for 20% of neonatal deaths yearly. In this review, we focused on the origins of the commoner neonatal infections, and we define the role of obstetricians. Regarding group B Streptococcus, a key measure for the prevention of neonatal infection is the vaginal–rectal culture screening at term pregnancy. Intravenous penicillin is the first-line prophylaxis at the start of labor, with intravenous ampicillin as an alternative. First-generation cephalosporins or clindamycin are recommended in case of penicillin allergy. Concerning urinary tract infections (UTIs), guidelines recommend complete urinalysis and urine culture in the first trimester of pregnancy for the screening of asymptomatic bacteriuria. For lower UTIs, guidelines recommend nitrofurantoin as first-choice antibiotic. Amoxicillin or cefalexin are second-line antibiotics. For upper UTIs, guidelines recommend cephalexin per os as first line. Candida spp. colonization affects 20% of pregnant women; however, congenital fetal candidosis and Candida amnionitis are rare. First-line treatment in case of symptomatic vaginitis during pregnancy or asymptomatic colonization during the third trimester is vaginal clotrimazole. Fluconazole is not approved in pregnancy, especially during the first trimester. Genital mycoplasmas colonization during pregnancy is usually asymptomatic and associated with bacterial vaginosis. Colonization is related to neonatal respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), pneumonia, chorioamnionitis, and sepsis. Macrolides are the first-line treatment along with lactobacillus supplementation. In cases of preterm premature rupture of membranes or preterm labor, ceftriaxone, clarithromycin, and metronidazole are required to prevent intra-amniotic infection. Intra-amniotic infection affects 1 to 5% of deliveries at term and one-third of preterm ones and is associated with perinatal death, early-onset neonatal sepsis, RDS, BPD, pneumonia, meningitis, and prematurity-related diseases. Guidelines recommend a combination of ampicillin and gentamicin, and in case of caesarean section, an additional dose of clindamycin or metronidazole is required. In conclusion, obstetricians should be aware that the treatment of maternal infection during pregnancy can prevent potentially lethal infections in the newborn.
Key Points
Subject
Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health
Reference87 articles.
1. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000;L Liu;Lancet,2012
2. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014;S J Schrag;Pediatrics,2016
3. The challenges of neonatal sepsis management;R S Procianoy;J Pediatr (Rio J),2020
4. Perinatal group B Streptococcal Infections: virulence factors, immunity, and prevention strategies;J Vornhagen;Trends Microbiol,2017
5. Selective or universal screening for GBS in pregnancy (review);A P Brown;Early Hum Dev,2018