The influence of intrauterine infections (STARCH syndrome) and immune status on the pathogenesis of cerebral palsy.

Intrauterine infection - symptoms and treatment

The manifestation of infection directly depends on the timing of infection. For all intrauterine infections there are a number of common symptoms [1][6]:

• The first 2 weeks after conception are spontaneous early abortions.
• From 2 to 10 weeks - gross malformations incompatible with life (severe heart defects, brain defects, etc.), as a result, spontaneous abortion (miscarriage) or frozen pregnancy.
• From 10 to 28 weeks - early fetopathies (diseases and malformations of the fetus). A miscarriage or frozen pregnancy is possible.
• From 28 to 40 weeks - late fetopathies. Development of inflammation in different organs.
• During childbirth - inflammation in organs (myocarditis, pneumonia, etc.).

The presence of an intrauterine infection in a child can be suspected during childbirth. Infection may be indicated by the discharge of cloudy amniotic fluid with an unpleasant odor or meconium (newborn feces). Children with intrauterine infection are often born prematurely and develop asphyxia (oxygen starvation). From the first days, such children also experience:

• jaundice;
• low birth weight (less than 2.5 kg);
• various skin rashes;
• respiratory disorders (pneumonia, respiratory distress syndrome);
• lethargy;
• pale skin;
• febrile conditions or hypothermia (body temperature below 36.0 °C);
• cardiovascular failure;
• neurological disorders (decreased muscle tone, convulsions, bulging large fontanel, high-pitched scream, increased excitability);
• decreased appetite, delayed weight gain;
• gastrointestinal symptoms (regurgitation, vomiting, bloating, enlarged liver and spleen).

Herpes

Herpes infection in a newborn is caused by herpes simplex virus types 1 and 2 (herpes simplex and genital). The highest risk of infection of the fetus is when the mother becomes infected during pregnancy. With an exacerbation of a pre-existing infection, the probability of infection is no more than 5% [1].

Congenital defects are rare and may include hypoplasia (underdevelopment) of the limbs, microcephaly (significant reduction in the size of the skull), retinopathy (damage to the retina), and skin scars.

Clinical manifestations of herpes types 1 and 2 in newborns:

• prematurity;
• pneumonia;
• chorioretinitis (inflammation of the choroid and retina);
• rashes on the skin and mucous membranes;
• jaundice;
• meningoencephalitis (damage to the membranes and substance of the brain).

The most severe herpetic infection occurs when generalized forms occur (disruption of all organs and systems) and when the central nervous system (CNS) is affected. In case of infection during childbirth, the infection appears after 4-20 days (incubation period).

Late complications in children who have had a herpetic infection in utero: recurrent herpetic lesions of the skin and mucous membranes, central nervous system disorders, retardation in psychomotor development, encephalopathy (brain damage).

Chicken pox

If a woman had chickenpox during the period from 8 to 20 weeks of pregnancy, in 30% of cases a miscarriage or stillbirth occurs. Most children who survive develop skeletal malformations and neurological abnormalities [1]. The later the signs of congenital chickenpox appear, the more severe the course: skin rashes, hepatitis, pneumonia, myocarditis, intestinal ulcers. When a rash appears in the first 4 days of life, the disease is not severe.

Late complications in children who have had chickenpox in utero: developmental delay, diabetes mellitus, loss of vision, increased incidence of malignant tumors.

Cytomegalovirus infection

Intrauterine infection with cytomegalovirus is possible if a woman is infected for the first time, as well as if reactivation of a cytomegalovirus infection occurs (transformation of an inactive form of the virus into an active one). Infection during childbirth and breastfeeding is possible.

Congenital defects (if a pregnant woman is infected in the early stages): microcephaly, atresia (absence) of the biliary tract, paraventricular cysts (near the ventricles of the brain), polycystic kidney disease, heart defects, inguinal hernia.

Clinical manifestations of congenital cytomegalovirus infection:

• low birth weight;
• jaundice;
• enlarged liver and spleen;
• rash in the form of hemorrhages on the skin;
• pneumonia;
• chorioretinitis, keratoconjunctivitis (inflammation of the cornea and conjunctiva);
• neurological disorders (meningoencephalitis, cerebral calcifications around the ventricles);
• blood in stool;
• thrombocytopenia (decreased platelet count), anemia;
• severe bacterial infections [14].

Late complications develop, as a rule, after the neonatal period: cerebral palsy, delayed psychomotor development and speech development, difficulties in school, damage to the kidneys, visual and hearing organs [1].

Measles

If you are infected with measles in the early stages of pregnancy, birth defects and miscarriages may develop.

Clinical manifestations in newborns:

• rash - occurs in 30% of children if the woman was sick during childbirth;
• prolonged jaundice;
• increased incidence of pneumonia if immunoglobulin G is not administered.

Parvovirus infection

Congenital defects are not common, but there is a high risk of fetal death if the mother becomes ill in the first half of pregnancy.

Clinical manifestations in newborns:

• fetal edema with severe anemia;
• thrombocytopenia.

ARVI

The most common causes of intrauterine infections are the following infections: adenovirus, influenza, parainfluenza, RS virus.

Congenital defects occur, but there are no characteristic ones.

Clinical manifestations are noted from the first days of life:

• catarrhal phenomena (swelling, inflammation and redness of the mucous membranes): rhinitis, pharyngitis, conjunctivitis, bronchitis, pneumonia;
• possible increase in body temperature (above 38 °C);
• poor weight gain;
• possible jaundice;
• Bacterial infections are often associated.

Late complications of past infection:

• hydrocephalus (dropsy of the brain) - accumulation of cerebrospinal fluid in the intracranial spaces, manifested by an increase in the size of the head;
• delayed psychomotor development;
• frequent ARVI;
• glomerulonephritis - damage to the glomeruli of the kidneys (after parainfluenza) [1].

Coxsackie virus

Congenital defects (if infected early): heart and kidney defects.

Clinical manifestations in newborns:

• low birth weight;
• diarrhea;
• rash;
• fever;
• signs of ARVI (nasopharyngitis);
• pneumonia.

Possible late complications of the infection: encephalopathy, myocardial dystrophy (damage to the heart muscle), chronic pyelonephritis [1].

Viral hepatitis B

Congenital defects and diseases: atresia (absence) of the biliary tract, hepatitis.

Clinical manifestations in newborns:

• prematurity;
• low birth weight;
• weight loss;
• diarrhea;
• enlarged belly;
• dark urine;
• discolored stool;
• acute, subacute and chronic hepatitis.

Possible late complications of the infection: delayed psychomotor development, cirrhosis of the liver, liver tumors.

Syphilis

One of the negative trends in recent years is the predominance of cases of congenital syphilis in women diagnosed with early syphilis. Congenital syphilis can be prevented by identifying and treating those infected during pregnancy. Therefore, pregnant women are repeatedly examined for this disease (blood on RW). Early congenital syphilis appears at 2-4 weeks of life, often even later.

Congenital defects: not typical.

Clinical manifestations in newborns:

• A typical triad is: rhinitis (runny nose), pemphigus (rash on the body), enlarged liver and spleen.
• Characterized by poor weight gain, anxiety, causeless shuddering, and central nervous system damage.

Possible late complications: hydrocephalus, encephalopathy [1].

Toxoplasmosis

There is a high probability of infection of the fetus if the infection is “fresh”. If infected in the 1st trimester, the probability is 15%, in the 2nd trimester - 30%, in the last trimester - more than 50%.

Congenital defects: malformations of the eyes (microphthalmia), brain (microcephaly, hydrocephalus), skeleton, heart.

Clinical manifestations in newborns. Three flow options are possible:

1. Acute - increased body temperature, enlarged lymph nodes, enlarged liver and spleen, edema, jaundice, diarrhea, skin rash.
2. Subacute - the main signs of encephalitis.
3. Chronic - hydrocephalus, calcifications in the brain, seizures, blurred vision.

Late complications: encephalopathy with oligophrenia (mental retardation), intracranial hypertension, epilepsy, eye and hearing damage (up to deafness and blindness) [1][3].

Chlamydia

The risk of transmission of infection to an infant at birth from an infected mother is 60-70%. The disease does not appear immediately, but after 5-14 days.

Congenital defects are not common.

Clinical manifestations in newborns:

• purulent conjunctivitis with severe edema;
• nasopharyngitis;
• otitis;
• pneumonia;
• urethritis.

Late complications of a previous infection: frequent and prolonged acute respiratory viral infections.

Rubella

If the mother is infected in the early stages, the pregnancy must be terminated [7]. Infection of a pregnant woman in the first months, especially before 14-16 weeks, leads to spontaneous abortion, stillbirth, and the development of multiple and gross defects in the fetus. Before planning a pregnancy, it is necessary to be examined: if a woman does not have antibodies, then she must be vaccinated against rubella.

Congenital defects: heart defects, eye defects, deafness. These are the main signs of congenital rubella. When infected with rubella during a long period of pregnancy, there may be no congenital heart defect, only damage to the organs of hearing and vision is possible.

Other clinical manifestations:

• prematurity;
• dropsy of the brain (hydrocephalus);
• enlarged liver, spleen;
• thrombocytopenic purpura, etc.

Possible late complications: disability, hydrocephalus, deafness, blindness, retardation in psychomotor and speech development, mental retardation.

Mycoplasmosis

Mycoplasma infection occurs more often during childbirth. When mycoplasmosis is detected in pregnant women, therapy is carried out after the 16th week of pregnancy, which reduces the incidence of morbidity in newborns.

Congenital defects are possible, but there are no characteristic defects for mycoplasma infection.

Clinical manifestations in newborns:

• prematurity;
• pneumonia;
• pale skin;
• respiratory distress syndrome;
• skin rashes (like small hemorrhages);
• meningoencephalitis.

Late complications of the infection: hydrocephalus, encephalopathy [1].

How does an embryo become infected?

IUI develops in three ways:

• hematogenous or transplacental, such as viruses, listeriosis, toxoplasmosis, syphilis (infection in the first trimester leads to deformities of the baby and developmental defects; if the embryo is infected in the last 3 months of gestation, the newborn is born with symptoms of an acute form of the disease)
• ascending (this is how herpetic infection, chlamydia, mycoplasmosis can be transmitted; the child becomes infected through the woman’s genital tract, this mainly happens during childbirth. If the infection gets into the amniotic fluid, the child’s gastrointestinal tract, respiratory tract, and skin will be affected)
• descending (the infection reaches the embryo through the fallopian tubes, which happens if the mother develops oophoritis, adnexitis)

Diagnosis of chickenpox

Chickenpox is diagnosed primarily by the typical clinical picture.

In laboratory diagnostics, to identify the causative agent of chickenpox, the polymerase reaction method and determination of the DNA of the virus are used.

• Varicella-Zoster virus (VZV), qualitative determination of DNA.
• Varicella-Zoster virus (VZV), qualitative determination of DNA (whole blood).

Serological diagnosis is aimed at identifying specific antibodies to the varicella zoster virus:

• Varicella-Zoster virus (VZV), IgM.
• Varicella-Zoster virus (VZV), IgG.

The microscopic method is used to verify the causative agent of chickenpox - identification of Aragao bodies (virus accumulation) in a smear from the contents of the vesicle, stained with silver by Morozov.

Scarlet fever is an acute infectious disease caused by group A beta-hemolytic streptococcus. It is characterized by fever, intoxication, acute tonsillitis and pinpoint rash.

The causative agent of scarlet fever is group A beta-hemolytic streptococcus. Scarlet fever is transmitted by airborne droplets. The source of infection is a sick person or a bacteria carrier.

Manifestations of neonatal herpes

A rash appears on the forehead, edges of the lips, cheeks, chin, and wings of the nose. When the virus infects the mucous membrane, aphthae appear in the mouth, and they can also form on the mucous membrane of the vulva, pharynx, and urethra. In case of eye damage with herpes, follicular, catarrhal conjunctivitis is diagnosed. For herpes in a newborn:

• A slight fever appears.
• Your health deteriorates significantly.
• The area of ​​the rash hurts.
• After opening the vesicles, erosions with hemorrhagic crusts form. They heal for a very long time.
• Lymph nodes enlarge.

The generalized form is especially dangerous for babies, in which the general condition sharply worsens, thermoregulation is disrupted, and the baby constantly regurgitates. A severe form can result in inflammation of the nervous system - meningitis, encephalitis, bacterial infection.