Children of Chemically Involved Parents : Herpes, Chlamydia, Hepatitis B, HIV

by Child Welfare Information Gateway

(Page 4 of 10)

Herpes

Congenital herpes infection occurs prenatally or by transfer from mother to fetus as the newborn passes through the vaginal canal and is exposed to the herpes virus. The mother may be completely without symptoms, or she may have vesicular (blisterlike) lesions on her genitals that contain the virus. Symptoms in infected infants range from a few herpes lesions on the skin to viral invasion of all organ systems, including the CNS. The effects can be quite serious and include severe mental and/or motor impairments, seizures, and/or visual disability. Infected infants are at increased risk for developmental problems.

Because initial symptoms may appear shortly after birth or as long as 1 month after delivery, careful followup for signs of blisterlike lesions or illness is recommended for all infants born to mothers known to have genital herpes infections.

Chlamydia

Chlamydia is a bacterial infection that may be transmitted from the mother to the infant during vaginal delivery. Generally, an infant's first symptom of infection with chlamydia is conjunctivitis that usually appears from a few days to a few weeks after birth. The eye often appears red and swollen with a watery discharge. If an infant infected with chlamydia is not treated, he/she may develop a pneumonia that generally is recognized at 1 to 4 months of age when the baby develops a chronic cough. Both chlamydia conjunctivitis and chlamydia pneumonia must be treated with oral antibiotics. Topical eye drops administered at birth do not prevent chlamydia infection. Because symptoms of chlamydia infection often do not appear until after hospital discharge, any infant who develops conjunctivitis, cough, or respiratory infection should be evaluated by his/her health care provider.

Hepatitis B

Hepatitis B is an infection of the liver that usually is transmitted in adults by sexual contact or sharing of contaminated drug needles. The hepatitis virus can be acquired by infants in utero or during the delivery process. Neonates who are at risk for hepatitis B infections include infants born to injection drug-using mothers, prostitutes, and mothers who have relationships with men who are at risk for hepatitis B infection. Untreated, infected infants may develop chronic liver disease. They also are at increased risk of developing liver cancer later in life.

Because of the increasing prevalence of this disease, many physicians recommend screening all substance-abusing mothers for hepatitis B infection prior to and at the time of delivery.

Infants whose mothers carry the hepatitis virus are treated with hepatitis B immune globulin (HBIG) and hepatitis B vaccine within the first day of life. Subsequently, hepatitis B vaccines are given at 1 and 6 months. A blood test is usually performed at 9 months to determine if an additional dose of the vaccine is needed. Caregivers need to coordinate this ongoing health care with a pediatrician.

Human Immunodeficiency Virus (HIV) Infection

Most newborns who have HIV infections contract them from their infected mothers. This virus, which causes AIDS, can be transmitted prenatally, at the time of delivery, or through breast milk. Infants born to mothers in the following groups are at increased risk for HIV infection:

• women with evidence of HIV infection;
• women who are injection drug users;
• women who are prostitutes;
• women with multiple sexual partners;
• women who are sexual partners of bisexual men, men who are injection drug users, men with multiple sexual partners, or HIV-infected men; and
• women who have lived in countries with high rates of heterosexual transmission of HIV.

Not all infants born to HIV-infected mothers will acquire the disease. The precise rate of infection is currently unknown. Those infants who test positive for HIV infection and subsequently develop physical signs of pediatric AIDS during the first year have a very poor prognosis. The long-term prognosis for infants who test positive for HIV infection but remain asymptomatic is unknown. The prognosis for infants who test negative despite their mothers' infection is also uncertain, because an infant who initially has a negative test may later show evidence of infection.

Testing for the HIV virus in all infants of mothers in high-risk groups has been recommended to provide early diagnosis and aggressive treatment of HIV-related infections as well as prevent viral transmission to caregivers.

Infants born to mothers who test positive for the HIV virus must have repeated periodic testing, even if their initial tests are negative.

All HIV-positive infants should be referred to a specialized health care team. A modified vaccination schedule is indicated for infants with the HIV virus, and specialized treatment is required for appropriate health care management.

Caregivers of HIV-positive infants will need special training and may require a range of supportive services.

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