Table 2.
Risk of vertical transmission, fetal/neonatal consequences, diagnosis and treatment.
| Virus | Risk of Vertical Transmission | Foetal/Neonatal Consequences | Diagnosis in Utero/after Delivery | Treatment of the Neonate |
|---|---|---|---|---|
| CMV | 25% to 40% with primary infection and <2% with secondary infection | Microcephaly, foetal growth restriction, low birth weight, hepatosplenomegaly, sensorineural deafness, retinitis, thrombocytopenia, visual impairment | Amniocentesis for viral PCR ~5 weeks from infection. At birth, viral PCR from urine or oral swabs obtained within 3 weeks. |
Valganciclovir or ganciclovir commenced within 4 weeks. |
| HAV | Very rare (few reported cases) | Ascites, meconium peritonitis, perforation terminal ileum, Jaundice | Not usually performed in utero Neonatal blood for serology and virology |
No specific treatment |
| HBV | 70% to 90% for hepatitis e antigen positive mothers and 20–40% for hepatitis e antigen negative | Persistent chronic hepatitis | Not usually performed in utero Neonatal blood for serology and virology |
Intramuscular HBIG 0.5 mL to neonates and HBV vaccine within 12 h of birth |
| HEV | 23% to 50% | Miscarriage, stillbirth, and neonatal hepatitis E infection | Not usually performed in utero Neonatal blood for serology and virology |
No specific treatment |
| HSV-2 | 30% to 50% with primary infection and 0–3% with recurrent infection at the time of vaginal delivery | Neonatal herpes presenting with Skin, mouth and/eye disease; Local CNS (e.g., encephalitis), hepatitis, and disseminated infection |
Not usually performed in utero Neonatal swabs (nasopharynx, anal, conjunctivae, mouth) for viral isolation/PCR |
Aciclovir (intravenous) at a dose of 20 mg.kg every 8 h until active disease excluded |
| PB19V | Up to 33% | Hydrops fetalis, myocarditis | Viral PCR of cord blood | If anaemia, red cell transfusion. If high viral load persist—consider immunoglobulin (IVIG) |
| RBV | 80% in the 1st trimester with up to 90% of fetuses affected. 25% to 30% affected >16 weeks with minimal effect of the fetus |
Microcephaly, cataract, congenital glaucoma, congenital heart disease, hearing impairment, hepatosplenomegaly, purpura, jaundice, radiolucent bone disease developmental delay, pigmentary retinopathy | Viral isolation and RT-PCR form nasopharyngeal swabs | No specific treatment available |
| VZV | 24% in 1st trimester | Affect skin, eyes and CNS and limbs. Eyes—chorioretinitis, cataract, nystagmus, cortical atrophy Limbs—atrophy, malformed digits, hypoplasia CNS—microcephaly, atrophy of the brain Autonomic nervous dysfunction—neurogenic bladder, hydronephrosis, oesophageal dilatation gastrointestinal reflex) Neonatal disease—pneumonia, meningoencephalitis, severe coagulopathy |
From characteristic features of congenital VZV or detection of virus with PCR from neonate (blood or lesions) | Varicella immunoglobulin (VZIG) to neonate born within 5 days of the mother’s rash or 2 days after the rash develops. Not given to those whose mothers had shingles. Intravenous aciclovir to infected neonates especially those with disseminated disease |
| ZIKV | 47% (26% to 76%) | Microcephaly, brain atrophy, cerebral and ocular calcifications, ventriculomegaly, periventricular cysts, callosal abnormalities, vermes agenesis, cerebellar atrophy, cortical atrophy | Classical features of congenital ZIKV syndrome; Swabs from placenta and cord blood for viral PCR. IgG and IgM in cord blood | No specific treatment |
CMV: cytomegalovirus; HAV: hepatitis V virus; HBV: hepatitis B virus; HEV: hepatitis E virus; PB19V: parvovirus B19; RBV: rubella virus; ZIKV: zika virus; VZV: varicella virus; PCR: polymerase chain reaction; RT-PCR: reverse transcription PCR; CNS: central nervous system; HBIG: hepatitis B immunoglobulin; IVIG: intravenous immunoglobulin.