RECOGNITION AND ASSESSMENT
Brain
- Intracranial calcifications
- Microcephaly
- Hydrocephaly
- Seizures
Blood
- Disseminated intravascular coagulation
- Cytopenias
- Bleeding
- Lymphadenopathy
Skin
- Vesicular or bullous lesions
- Pustular or scarring lesions
- Petechiae or purpura
- Condylomata lata
- Desquamation (hands and feet)
In-utero
- Intrauterine growth restriction
- Oligo -or polyhydramnios
- Hydrops
Eyes and ENT
- Microphthalmia
- Congenital cataracts
- Chorioretinitis or keratitis
- Sensorineural hearing loss or failed newborn hearing screen
- Haemorrhagic rhinitis
- Saddle nose
Skeletal
- Bony abnormalities
- Limb malformations
System involvement
- Sepsis
- Myocarditis
- Congenital cardiac anomalies
- Congenital glomerulonephritis
Liver
- Hepatitis
- Hepato- or splenomegaly
- Jaundice
- Ascites
INVESTIGATIONS
- If history of foreign travel in pregnancy, discuss with paediatric infectious diseases
Table 1
| Clinical scenario | S | C | O | R | T | C | H | ||||
| Parvo-virus B19 | Entero-virus | Other | VZV | HSV | HIV | Hepatitis B/C | |||||
| Abnormal brain development | ✓ | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | ✓ | - | - |
| Sepsis | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | ✓ | - | - | |
| Petechiae/purpura, extramedullary haematopoiesis | ✓ | ✓ | ✓ | - | - | ✓ | ✓ | ✓ | ✓ | - | - |
| Blisters | ✓ | ✓ | - | - | - | ✓ | ✓ | ✓ | - | - | |
| Intrauterine growth restriction | ✓ | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | - |
| Abnormal antenatal scans* | ✓ | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | - |
| Eye disease | ✓ | ✓ | - | - | ✓ | ✓ | ✓ | ✓ | ✓ | - | - |
| Hearing loss | ✓ | ✓ | - | - | ✓ | ✓ | ✓ | ✓ | ✓ | - | - |
| Limb abnormalities | ✓ | - | - | - | ✓ | ✓ | ✓ | - | - | - | |
| Cardiac abnormalities | ✓ | - | - | ✓ | ✓ | ✓ | - | - | - | - | |
| Liver abnormalities | ✓ | ✓ | - | ✓ | - | ✓ | ✓ | - | ✓ | - | - |
| No antenatal booking bloods** | - | - | - | - | - | - | - | - | - | ✓ | ✓ |
* Periventricular calcification, hyperechogenic bowel, ventriculomegaly, microcephaly, fetal growth restriction, hydrops
** URGENT sample required: HIV, syphilis (paired – not cord blood), hepatitis B serology
Key
| S | Syphilis |
| C | Cytomegalovirus |
| O | Other |
| R | Rubella |
| T | Toxoplasmosis |
| C | Chicken pox |
| H | Herpes simplex and other blood borne viruses |
Specific investigations
- Send placental samples for histopathology and microbiology/virology stating ‘suspected congenital infection’
Syphilis
- See Syphilis – babies born to mothers with positive serology guideline for investigations and management
CMV
- See CMV guideline for investigations and management
Other
Parvovirus B19
- PCR: blood
Enterovirus
- PCR: blood, NPA/nasal secretions, skin lesions if appropriate
Rubella
- PCR: blood and saliva
- Audiology and ophthalmology review
Toxoplasmosis
- Paired maternal/infant serology (not cord blood)
- Add serology to booking bloods
- PCR: neonatal blood, placenta
- Placental microscopy
- Cranial US +/- MRI head
- Audiology and ophthalmology review
Chickenpox (VZV)
- See Fetal varicella syndrome section of Varicella guideline
HSV, HIV, Hepatitis, HTLV-1
- See Herpes simplex virus (HSV), Human immunodeficiency virus (HIV) and Hepatitis B and C guidelines
If high clinical suspicion or positive results refer to paediatric infectious diseases
Date updated: 2024-01-12