levoleucovorin and Infant--Premature--Diseases

The clinical management of perinatal toxoplasmosis involves a gynaecologist during pregnancy and a neonatologist after delivery. Then, in the absence of a uniform approach, early evaluation of infected infants requires a thorough long-term follow-up also in asymptomatic children, who have to be observed for at least one year due to unpredictable sequelae in later life. We retrospectively analyzed pregnancy management of 54 women with certain infection from Toxoplasma gondii (TG) and prospectively enrolled their infants to compare prenatal management with postnatal clinical outcome. All mothers with seroconversion for TG infection were from the Palermo area and were retrospectively analyzed, whereas their newborns referred to G. Di Cristina Children Clinical Hospital between 1999-2004 were prospectively enrolled in a 48-month follow-up. Timing of infection was dated for 24 women (45%) to the first trimester, 18 (33%) to the second and 12 (22%) the third. The maternal-fetal transmission rate was 17.2%. Prenatal diagnosis from amniotic fluid was performed in 25/54 pregnant subjects and showed positive results in 6. Despite diagnosis of TG infection, 9 women were untreated and only 2 with positive amniocentesis received combined therapy. 10/55 enrolled infants were infected and half of them were preterm and/or SGA at birth. None showed peculiar signs of TG at birth but 4 had abnormalities during the follow-up. 9/10 infected children were born to mothers who had undergone neither amniocentesis nor combined therapy.. Our work confirms the difficulty of applying standardized therapeutic protocol for TG infection during pregnancy. The asymptomatic course of TG infection at birth confirms the importance of an instrumental long-term follow-up to identify typical TG lesion to prevent sequelae.

Topics: Adolescent; Adult; Amniocentesis; Animals; Antibodies, Protozoan; Antiprotozoal Agents; Chorioretinitis; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Hydrocephalus; Immunoglobulin G; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Small for Gestational Age; Infectious Disease Transmission, Vertical; Italy; Leucovorin; Male; Prednisone; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimesters; Prenatal Care; Prospective Studies; Pyrimethamine; Retrospective Studies; Spiramycin; Sulfadiazine; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Cerebral; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular

The majority of clinically recognizable acute infections in the neonate are bacterial. Such infections may be acquired from the mother prior to or at birth or from environmental sources. Because of the limited ability of neonates--especially those born prematurely--to express symptoms, even minor deviations from normal behavior should suggest bacterial disease. Chronic congenital and perinatal infections, unlike acute bacterial disease, are generally asymptomatic in mother and neonate and may remain latent or subclinically active in host tissue for prolonged periods, possibly causing insidious injury to the central nervous and perceptual systems. When overt, these infections almost invariably cause mental or perceptual handicaps or both. In view of the significant mortality and morbidity associated with either acute or chronic infections, diagnosis and treatment should be aggressive.

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Chronic Disease; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Infections; Leucovorin; Penicillin G Benzathine; Pyrimethamine; Sulfadiazine; Syphilis; Toxoplasmosis