This will present as prematurity, hepatosplenomegaly, being small for gestational age, having a small head, microcephaly, which is similar to toxo, or having seizures.
HIV is also on at increasing prevalence
in pregnant women in the
United States and worldwide.
Sometimes people feel like HIV is getting
less frequent in the United States
because we’re doing a better
job of providing condoms.
But remember, the patients with HIV now
are getting excellent care in the U.S.
and they aren’t dying and they
may go on to get pregnant.
So actually, the rates in
pregnant women are going up.
Thus, transmission rates are
important to keep track off.
A patient is more likely to acquire
transmission of HIV in utero
if the mother’s
viral load is high.
On average, if the mother is not aware
of her disease or is not treated,
which is one in four HIV
A quarter of those babies
will go on to acquire HIV.
However, if we find out the mother is
positive just at the time of delivery,
we can intervene with the baby
and provide HIV medications and
reduce that transmission rate to 6%.
And if we’re aware of mom’s
status while she’s pregnant,
we can drop that all the
way down to less than 2%.
So undiagnosed babies with HIV
really don’t need to occur if we’re
routinely screening pregnant women,
but it does happen.
And undiagnosed babies usually present
a little bit later on in life
with opportunistic infections
or failure to thrive.
So all women need to be routinely
tested during pregnancy,
all of them.
Rich or poor or black or
white, it doesn’t matter.
We need to test
every one for HIV.
Routine screening of infants at birth
for mothers who are not tested, further
prevents infection in two ways.
First, it dramatically raises the
rate at which women get tested
and it then catches those
babies who are missed
and reduces their risk of
infection from 25% to 6%.
And rapid testing is effective in infants.
So we can check real quick.
If a mother is exposed,
we should test the infant with
quantitative PCR at regular intervals
to wait and see if this
child turns positive.
Remember that even if the baby doesn’t
have HIV and the mother does,
that baby may have a positive antibody
test as long as 18 months after delivery
because mom’s antibodies
can persist in the baby
because of transplacental spreads
for a long period of time.
How do we treat babies?
We give them HAART therapy.
We do that for confirmed, infected infants.
During delivery, we will give mothers
AZT and that can reduce transmission.
Also, if a mother is known
to have a high viral load,
we may proceed directly to C-section
to reduce risk to the infant.
Exposed infants will get AZT
orally for six weeks after birth.
And infants will get trimethoprim
until the HIV status is
known to be negative.
Let’s switch gears one
more time to rubella.
Rubella is rare in the U.S.
because we have a vaccine,
the measles-mumps-rubella vaccine,
which is a great vaccine.
Rubella is an RNA virus.
And primary infection
is not such a big deal.
Patients will get a low-grade
fever, they’ll get headache,
maybe conjunctivitis, maybe
cough and congestion
And they will get a classic rash.
Here’s a classic rash of
a patient with rubella.
But it’s not really the primary infection
that we’re worried about in children.
What we’re worried about is the
other getting a primary infection
while the infant is inside them.
So if a mother acquires the
disease while she’s pregnant,
the infant can be
Stillborn babies are reasonably
common with congenital rubella.
Or they may have a triad of symptoms.
So the classic triad of rubella is
cataracts, like we can see here,
deafness and cardiac defects.
So eyes, ears, and heart.
In addition to this triad, infants may
be born with blueberry muffin spots.
This is a commonly
These muffin spots are different than the
rash I showed you in the previous patient.
That was just acquired rubella.
This is congenital rubella and they
develop these blue lesions in their skin.
These blue lesions are because there
is actually extramedullar hematopoiesis
going on in the skin in these infants.
Let’s switch gears now to
congenital CMV or cytomegalovirus.
This the most common congenital
infection in the United States.
Fortunately, the majority are asymptomatic.
But 10% will have symptoms at birth.
This will present as
being small for gestational age,
having a small head, microcephaly, which
is similar to toxo, or having seizures.
They may also have late symptoms,
which include hearing, vision loss,
developmental delay or
a seizure disorder.
So early symptoms are fairly non-specific
except they do have microcephaly
and then later symptoms, they can
develop hearing and vision loss,