Intrauterine infection

1. INTRAUTERINE
INFECTIONS

2. DEFINITION
INFECTIOUS DISEASES AND
PROCESSES THAT CAUSED BY
PATHOGENS WHICH HAVE ENTERED
THE FETUS FROM AN INFECTED
MOTHER BEFORE DELIVERY OR
DURING THE PASSAGE OF THE FETUS
THROUGH THE BIRTH CANAL ARE
COMBINED IN THE CONCEPT OF
INTRAUTERINE INFECTIONS.

3. EPIDEMIOLOGY
• THE PREVALENCE OF IUI AMONG NEWBORNS IS
ABOUT 10%.
• HOWEVER, ONLY 10% OF INFECTED NEWBORNS
BECOME ILL DURING THE NEONATAL PERIOD.
IN OTHER CHILDREN, IUI IS ASYMPTOMATIC OR
HAS DIFFICULT TO DIAGNOSE CLINICAL
SYMPTOMS.

4. EPIDEMIOLOGY
• THE SOURCE OF INFECTION IS A PREGNANT WOMAN.
• FOR THE FETUS, THE MOST DANGEROUS PATHOGENS
OF INFECTIOUS DISEASES THAT A PREGNANT WOMAN
FIRST ENCOUNTERED DURING PREGNANCY BECAUSE
DURING THIS PERIOD, THE PRIMARY IMMUNITY IS
MODIFIED (RELATIVELY REDUCED), WHILE THE
SECONDARY IMMUNITY IS PRESERVED.
• IT IS ESSENTIAL TO IDENTIFY SERONEGATIVE WOMEN
BEFORE PREGNANCY.

6. RISK FACTORS FOR IUI
• BURDENED OBSTETRIC HISTORY (STILLBIRTHS,
MISCARRIAGE, ABORTIONS – ESPECIALLY
DURING THE FIRST PREGNANCY).
• CHRONIC DISEASES OF URINARY SYSTEM.
• CHRONIC DISEASES OF REPRODUCTIVE SYSTEM.
• ACUTE INFECTIOUS DISEASES DURING
PREGNANCY (ACUTE RESPIRATORY INFECTIONS,
ACUTE TONSILLITIS, BRONCHITIS).

7. PATHWAYS OF INFECTION TO THE
FETUS
• HEMATOGENIC-TRANSPLACENTAL.
• DESCENDING PATHWAY OF AMNIOTIC FLUID INFECTION
(INFLAMMATION OF THE TUBES AND APPENDAGES).
• THE ASCENDING PATHWAY.

9. PATHOMORPHOLOGICAL
CHARACTERISTICS OF INDIVIDUAL STAGES
1. PHASE BLASTOGENESIS
(FERTILIZATION – 15TH DAY OF
GESTATION) – BLASTOPORE;
2. EMBRYONIC DEVELOPMENT PHASE
(DAY 16 – 75) – TERATOGENIC EFFECT;

11. PATHOMORPHOLOGICAL
CHARACTERISTICS OF INDIVIDUAL STAGES
3. EARLY FETAL PERIOD (75 – 181 DAYS) -
FINE STRUCTURAL DIFFERENTIATION OF
TISSUE - INFLAMMATORY REACTION
WITH ALTERATION AND PROLIFERATION.
4. LATE FETAL PERIOD (181-280 DAYS) -
FETAL MATURATION - INFLAMMATORY
REACTION WITH ALTERATION,
PROLIFERATION, EXUDATION.

12. CONSEQUENCES OF VARIOUS
INFECTIONS

13. IUI PERIODS
• INCUBATION PERIOD.
• PERIOD OF CLINICAL MANIFESTATIONS.
• REMISSION, RECOVERY.
• RESIDUAL PERIOD (RESIDUAL
MANIFESTATIONS).

14. COMMON SIGNS OF IUI
 TERATOGENIC EFFECT;
 PROCESS GENERALIZATION;
 PERSISTENT, LONG-TERM COURSE (SLOW INFECTION);
 HIGH PROBABILITY OF COMBINED (MIXED) AND COMPLEX
PATHOLOGY (INFECTIOUS);
 LOW SPECIFICITY OF THE CLINICAL PICTURE.
IUI FORMS
 GENERALIZED (MOSTLY);
 LOCALIZED (RARELY).

16. LOCALIZED FORM
(PURULENT CONJUNCTIVITIS)

17. LOCALIZED FORM
(PURULENT OMPHALITIS)

18. COMMON SYMPTOMS
OF PERINATAL INFECTIONS
 HEPATOSPLENOMEGALY;
 JAUNDICE;
 EXANTHEMAS
(MACULOPAPULAR,
PETECHIAL, DRAINING,
HEMORRHAGIC);
 PNEUMONIA;
 PURULENT LESIONS OF THE
SKIN AND FAT TISSUE;

19. COMMON SYMPTOMS
OF PERINATAL INFECTIONS
 MENINGOENCEPHALITIS;
 CALCIFICATION OF THE BRAIN;
 OSTEOPOROSIS;
 HORIORETINIT;
 CATARACTФ;
 THROMBOCYTOPENIA;
 ANEMIA.

20. SEPSIS - acyclic disease, which is based on
a organism systemic inflammatory response
of an immune complex to a bacterial
infection with the development of multiple
organ failure.

21. • RESPIRATORY SYSTEM: RESPIRATORY ACIDOIS,
HYPERVENTILATION, RESPIRATORY DISTRESS
SYNDROME.
• CARDIOVASCULAR SYSTEM: DECREASED CARDIAC
OUTPUT, VASOCONSTRICTION, ORGAN
HYPOPERFUSION, REFRACTORY HYPOTENSION.
• KIDNEY: HYPOPERFUSION, DAMAGE OF RENAL
TUBULES.
MULTIPLE ORGAN FAILURE
SYNDROME

22. MULTIPLE ORGAN FAILURE
SYNDROME
• LIVER: INCREASED BILIRUBIN AND
TRANSAMINASES.
• MENTAL STATUS: AGITATION OR INHIBITION, LOSS
OF COMMUNICATION SKILLS, ANOREXIA,
CONVULSIONS.
• HEMATOLOGICAL INDICATORS: LEUKOCYTOSIS,
TOXIC GRANULARITY, THROMBOCYTOPENIA, +CRP,
MONOCYTOSIS(PENIA).

23. CLINICAL PICTURE
• CARDIOVASCULAR SYSTEM:
- BRADYCARDIA/TACHYCARDIA;
- CYANOSIS;
- MICROCIRCULATION DISORDERS, "WHITE
SPOT" SYMPTOM (CAPILLARY BLOOD FILLING
TIME > 3 SECONDS);
- ARTERIAL HYPOTENSION (LATE SYMPTOM);
- SEVERE PERIPHERAL EDEMA.

24. CLINICAL PICTURE
GASTROINTESTINAL TRACT:
- LACK OF APPETITE;
- -SLOW EVACUATION OF
FOOD FROM THE STOMACH,
REGURGITATION, VOMITING;
- LIQUID, WATERY STOOL,
TRACES OF BLOOD IN THE
STOOL;
- SWOLLEN BELLY;
- ENLARGEMENT OF THE
LIVER, SPLEEN;

25. CLINICAL PICTURE
• NERVOUS SYSTEM:
- "UNUSUAL BEHAVIOR";
- DROWSINESS, HYPOTENSION;
- INHIBITION OF PHYSIOLOGICAL REFLEXES;
- SWELLING OF THE LARGE FONTANELLE;
- CONVULSION;

26. CLINICAL PICTURE
• SKIN AND
SUBCUTANEOUS TISSUE:
- "DIRTY BABY";
- MARBLING, PALLOR;
- JAUNDICE;
- PETECHIAE,
HEMORRHAGES;
- SCLEREDEMA,
SCLEREMA

27. CLINICAL PICTURE
• THERMOREGULATION:
- INSTABILITY OF BODY TEMPERATURE;
- HYPOTHERMIA;
- INCREASED BODY TEMPERATURE
- A PROLONGED INCREASE IN BODY TEMPERATURE
IS USUALLY A SIGN OF INFECTION;
- IF THERE IS AN INFECTION, AN INCREASE IN BODY
TEMPERATURE IS ACCOMPANIED BY OTHER
SYMPTOMS;

28. CLINICAL PICTURE
• METABOLIC DISORDERS:
- HYPOGLYCEMIA OR HYPERGLYCEMIA;
- METABOLIC ACIDOSIS;
- HYPERBILIRUBINEMIA (A SIGNIFICANT PART
IS DIRECT BILIRUBIN)

29. CLINICAL PICTURE
• HEMATOLOGY:
- 50% OF CASES HAVE NORMAL WHITE BLOOD CELL
COUNT; LEUKOPENIA IS MORE COMMON IN
PREMATURE BABIES;
- QUANTITATIVE CHANGES IN NEUTROPHILS - A
MORE SENSITIVE SIGN (IN 75% OF PATIENTS);
- THE RATIO BETWEEN YOUNG FORMS AND ALL
NEUTROPHILS > 0.16-0.2 MORE - SENSITIVE
INDICATOR OF SEPSIS;
- THROMBOCYTOPENIA (< 80,000-100,000,LATE SIGN);

30. DIAGNOSIS OF NEONATAL SEPSIS
• BIOCHEMICAL ANALYSIS OF BLOOD:
- THE CONCENTRATION OF C-REACTIVE PROTEIN IN
THE BLOOD INCREASES IN 50-90% OF PATIENTS
WITH SEPSIS;
- C-REACTIVE PROTEIN (CRP) IS AN ACUTE PHASE
OF INFLAMMATION REAGENT THAT HAS A SHORT
HALF-LIFE AND QUICKLY NORMALIZES WITH
ADEQUATE TREATMENT- THIS USUALLY OCCURS
AFTER 24 HOURS FROM THE MOMENT OF
INFECTION

31. DIAGNOSIS OF NEONATAL SEPSIS
• MICROBIOLOGICAL EXAMINATION:
- CULTURES FROM THE SURFACE OF THE BABY'S
SKIN MAY INDICATE COLONIZATION OF THE
MOTHER'S BIRTH CANAL
- FOR THE DIAGNOSIS OF NEONATAL SEPSIS ARE
NOT SUITABLE
- BACTERIOSCOPY AND INOCULATION OF TRACHEAL
ASPIRATE FOR DIFFERENTIAL DIAGNOSIS OF RDS;
- URINE CULTURE IS NOT VERY EFFECTIVE FOR THE
DIAGNOSIS OF EARLY SEPSIS, BUT IT IS MORE
INFORMATIVE FOR LATE SEPSIS;

32. TREATMENT OF NEONATAL SEPSIS
• IT IS NECESSARY TO START AT THE SAME TIME
WITH THE MOTHER'S TREATMENT IN CASES:
- CHORIOAMNIONITIS IN THE MOTHER;
- PREMATURITY;
- INCREASED MATERNAL TEMPERATURE (>
37.8°C)DURING CHILDBIRTH;
- WATERLESS PERIOD > 18 HOURS;
- MOTHER'S URINARY TRACT INFECTION;
- CARRIAGE OF GROUP B STREPTOCOCCUS DURING
PREGNANCY;
- PREVIOUS CHILD BORN WITH STREPTOCOCCAL (B)
INFECTION.

33. TREATMENT OF NEONATAL SEPSIS
• TREATMENT OF A NEWBORN BABY:
- ANTIBACTERIAL THERAPY;
- SYMPTOMATIC AND POST-SYNDROME TREATMENT;
- INTRAVENOUS IMMUNOGLOBULIN;
- TRANSFUSION OF GRANULOCYTE MASS;
- REPLACEMENT BLOOD TRANSFUSION;
- INTRODUCTION OF RECOMBINANT HUMAN
CYTOKININ AND/OR A COLONY OF GRANULOCYTES-
MACROPHAGES OF THE STIMULATING FACTOR;

34. TREATMENT OF NEONATAL SEPSIS
• ANTIBIOTICS:
- START AB THERAPY AS SOON AS POSSIBLE;
- THE CHOICE OF AB DEPENDS ON THE
MICROFLORA, AGE OF THE NEWBORN,
CLINICAL SYMPTOMS, AND TIME OF INFECTION;
- if a hospital infection is suspected, the choice of AB therapy is
determined by the most common nosocomial infection, taking
into account the epidemiological situation in the Department
(current hospital, admitting hospital);
- neonatal sepsis should be treated with intravenous AB.

35. IMMUNOGLOBULINS FOR INTRAVENOUS
ADMINISTRATION
STANDARD IVIG:
INTRAGLOBIN F (GERMANY); HUMAN IMMUNOGLOBULIN
(RUSSIAN FEDERATION); IMMUNOGLOBULIN (AUSTRIA);
OCTAGAM (SWITZERLAND); SANDOGLOBULIN
(SWITZERLAND); ENDOGLOBULIN (AUSTRIA); BIAVEN V.
I. (ITALY); VIGAM-LIQUID, VIGAS-S (GB).
THE IMMUNOGLOBULIN ENRICHED WITH IGM: PENTAGLOBIN
(GERMANY).
SPECIFIC IMMUNOGLOBULINS:
CYTOTEC (ANTICYTOMEGALOVIRUS.); HEPATECT
(AGAINST HEPATITIS "B»); ANTISTAPHYLOCOCCAL
IMMUNOGLOBULIN.