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INFECTIONS IN PREGNANT WOMEN AND NEWBORNS_
THE ROLE OF SEXUALLY TRANSMITTED INFECTIONS IN PATHOLOGY OF NEWBORNS AND INFANTS
I. I. Evsyukova
D.O. Ott Institute of Obstetrics and Gynecology, RAMS, St. Petersburg, Russia.
■ The number of pregnant women with chronic somatic pathology having latent forms of genital infections has increased. In the present report, author discusses the rate and clinical forms of intrauterine infections. It is emphasized that an increase of asymptomatic forms of diseases, as well as the lack of timely diagnosis may contribute to persistence of the agent and cause negative consequences for the health of the infant.
The role of sexually transmitted infections in pathology of newborns and infants remains to be a problem, in spite of improvements in the quality of diagnostics in pregnant women. Urogenital infections in pregnant women caused by Chlamydia, Mycoplasma, Ureaplasma and viruses of the family Her-pesviridae are still of particular significance [1, 2]. At present, the number of pregnant women with latent forms of infections in a background of chronic somatic pathology has increased, which contributes to activation and dissemination of infectious agent with further consequences after birth and intrauterine fetus infection.
In case of diagnosis of chlamydial infection in pregnant woman followed by treatment with antibiotics (erythromycin or rovamycin, vilprafen, macropen) the rate of birth of infected newborn is 12.5 % — 13.5 %. After successful treatment of pregnant woman infected with U. urealyticum, the rate of birth of infected newborns is 5.9 0%, while if infection remains untreated 20.4 %%. During the recent years we observed an increase of the number of pregnant women with unsuccessful! treatment of Mycoplasma hominis infection (in year 2001 — 46.7 ± 12.9 %%, in year 2003 — 70.3 ± 7.5 %) [3]. The rate of intrauterine infections, caused by Herpes virus among children born in D.O. Ott Institute of Obstetrics and Gynecology in the last 6 years (11917 children) did not exceed 1 %.
During the last 10 years (1995 - 2005) in 37 %% of mature newborns and in 20 %% of premature newborns, asymptomatic C. trachomatis infection was observed; generalized form was detected in 5 % of cases [4]. Among newborns infected with Herpes virus, 45 % had no symptoms; symptomatic children chronic hypoxia as a result of chronic
subcompensated placental insufficiency. Myco-plasma and Ureoplasma in profoundly premature newborns usually caused meningoencephalitis, pneumonia, conjunctivitis, lesion of subcutaneous adipose tissue. Mycoplasma and Ureaplasma were detected in combination with other microorganisms (cytomegalovirus, herpes virus type II, C. trachomatis, Streptococcus agalactiae, Candida albicans). Of 109 mature newborns infected with U. urealyticum, 74% had no symptoms. Intrauter-ine infections were diagnosed in 10 newborns; only two them had U. urealyticum as a single detected causative agent [5].
Disappearance of severe generalized forms of chlamydial infection, on one side, is a positive fact, but on the other side, chlamydial infection that was not diagnosed in early neonatal period leads to a long term persistence of Chlamydia that, based on our data, impair formation of immune system and determines the development of allergic diseases, as well as chronic pathology of central nervous system and other functional systems of newborns [6, 7].
Prospective study of 45 newborns who had chlamydial infection showed that in the first year of life 84.6 %% of them turned out to be impaired. The majority of children (50.6 %%) had recurrent rhinitis and nasopharyngitis, and 37.4 %% of children had acute respiratory diseases. Functional disorders of the digestive tract in the form of frequent regurgitations, reduction of appetite, unstable stool has been detected in 37.4 %%, 33 %%, 35 % and 57 % of children, respectively. Besides, among the girls 43 %% had vulvitis; 33 %% of children had conjunctivitis, 17,6 % — otitis. This pathology was found in non-treated children or in those who were treated with erythromycin; in 65 % of the children persistence of the causative agent was found. After treatment with Sumamed on days 1, 7 and 14, persistence of the causative agent on the first year of life was not detected, all children showed mesosomatic harmonic development [8]. Consequently, early diagnosis of diseases in newborns from the high risk group of intrauterine chlamydial infection and appropriate therapy are of great importance for prevention of negative consequences of the disease.
»jthajit. riRS'uiEPCTBA» ¡kehckhxt. ECTOHER
VOL LVI SUP PLEMENT may/2007
ISSN 1684-0461 ■
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INFECTIONS IN PREGNANT WOMEN AND NEWBORNS
Treatment of acute form of chlamydial infection with macrolides gives fast clinical effect and provides practically complete elimination of the agent.
Our studies showed that infected mature new-borns usually have normal or increased production of IFN-aP and IFN-y, which has significance in anti-infectious resistance and determines the possibility of elimination of the agent. That is why those children have to be under regular medical check-up, they have to be repeatedly tested at the age of 2 and 6 months. In case of detection of Chlamydia, immunomoduling therapy is prescribed with further adding of etiotropic therapy with Sumamed taken on day 1, 7 and 14 (course dosage 60 mg/kg).
The role of breast feeding should be emphasized in treatment effectiveness of intrauterine infections of newborns. Our studies showed that in newborns who received Pre NAN milk formula at the 10 day of life the activity of lipid peroxidation and antiradical activity of the blood decreased, but its anti-oxidant activity increased. Our data indicates that in case of impossibility of breast feeding children should receive the adapted milk formula PreNAN with strong antioxidant effect. Our prospective studies showed that in case of rational breast feeding and good reaction from the interferon system in mature newborns elimination of causative agent takes place and normal physical and neuropsychic development is presented. This applies to treatment of asymptomatic forms of infection, caused not only by intracellular causative agents but also by Herpes virus. Regarding treatment of premature newborns, in every single case it has to be individual.
However, the influence of mother's infection on fetus does not only add up to development of infectious pathology. Analysis of clinical conditions of newborns whose mothers had chlamydial, Myc-oplasma or mixed infection during their pregnancy showed that even in the absence of intrauterine infection in 75 - 84 % of cases a malfunction of the central nervous system was detected, in 26 % — the heart-vascular system and the digestive tract, which was interpreted as index of "difficult adaptation" for new living conditions. Premature newborns (74 %) for a long time are being observed by neuropathologist and receiving the treatment concerning "perinatal encephalopathy". We assume that in the genesis of observed non-specific reactions of functional systems the central nervous system in newborns there is the development of autoimmune processes as a result of immunocomplex pathology of afterbirth. Changes in immune homeostasis and histostructure of placenta are accompanied by changes in oxidation processes [6]. Activation of
free radical oxidation in afterbirth contributes to damage of enzymatic and hormonal function of the placenta and development of placental insufficiency with well known consequences for intrauterine development of the fetus. That is why it is not rare that children born from mothers with chlamidial and/or Mycoplasma infection during pregnancy have high rate of infectious and allergic diseases and psychomotor development delay in the future [9, 10]. Consequently, prevention of intrauterine infections and their negative consequences for healthy children of early age consists in diagnosis of STIs and treatment of married couples at the stage of family planning, and after child birth — in thorough check-up and individualized choice of treatment.
References
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2. Chlamydial infection in obstetrics and gynecology (diagnostics, clinical manifestations, treatment). Methodical manual / Ed. Acad. RAMS, Honored PhD RF, PhD, professor E. K. Ail-amazyan. — SPb, 2002. — 46 p. [in Russian]
3. MorozovaA. V. Rate of infection and morbidity of children born from mothers with detected Ureaplasma / Morozova A. V., Matyenko I. V., Novikova L. N. // Z. Akus. Zen. Bolezn. — 2004. — Vol. LIII, N 4. — P. 38 - 41. [in Russian]
4. Evsyukova1.1. Relevant problems of diagnostic and treatment of chlamydial infection on modern stage / Evsyukova I. I., Korole-va L. I. // Pediatrics. — 2003. — N 2. — P. 82 - 87. [in Russian]
5. KorolevaL. I. Intrauterine infection by Ureaplasma urealyticum and morbidity of newborns / Koroleva L. I., Matyenko I. V. // In col: Annual scientific-practical conference of CIS countries — SPb, 2006. — P. 106 - 107. [in Russian]
6. Evsyukova 1.1. Role of infectious factor in development of perinatal pathology of fetus and newborn / Evsyukova I. I. // Vest-nic of perinat. — 1997.— N 4. — P. 25 - 27. [in Russian]
7. MalovaI. O. Urogenital infections in girls of young age (before 12): epidemiology, pathogenesis, clinical manifestations, diagnostics, prophylactic / Malova I. O. // Abstract PhD. — Moscow, 2000. — 44 p. [in Russian]
8. Patrusheva E. N. Consequences of intrauterine infection of fetus with Chlamydia / Patrusheva E. N., Evsyukova I. I., Bash-makova M. A., Savicheva A. M. // Russian vestnic of perinat. and pediatr. — 1993. — Vol. 38, N 4. — P. 9 - 11. [in Russian]
9. Evsyukova I. I. Intrauterine infections: mothers chlamidial infection and its influence on posterity / Evsyukova I. I. // Terra Medica, — 1996. N4. — P. 31 - 35. [in Russian]
10. Condition of health of intrauterine infected children / Korneva M. U. Korovina N. A. Zaplatnikov A. L. [et al.] // Russian vestnic of perinat. and pediatr. — 2005. — Vol. 50. N 3. — P. 48 - 52. [in Russian]
■ JfiJPJI.Ul AKVIIIF.r^TBV" XEHCKHXT. EOJI13HE3 VOLLVI SUPPLEMENT may/2007
ISSN 1684-0461
