Viral infection in newborns, symptoms and treatment. Treatment of ARVI in infants and newborns. The use of antipyretics

The fetus can be infected in many ways

Hearing loss is the most significant developmental abnormality in children with asymptomatic infection. One study found hearing loss in 2% of patients with asymptomatic infection. In 50% of these children, hearing loss was bilateral, and in 50% it progressed. The median age at first progression of hearing loss was 18 months. Eighteen percent of children delayed the onset of sensorineural hearing loss, with an average age of detection at 27 months.

Thirty percent of severely ill patients die from multiorgan dysfunction. A petechial rash develops within hours of birth and persists for 48 hours a few weeks after birth. The rash is also partly caused by the continuation of normal fetal hematopoiesis.

Microcephaly was found to be the most specific predictor of mental retardation. Mental retardation can also be predicted by the presence of intracranial calcifications, which predict at least moderate and probably severe mental retardation.

Seventy percent of children with symptomatic infection have psychomotor delay, usually with neurological complications and microcephaly. Hearing loss in 50% of patients with bilateral hearing loss in 67% and progressive hearing loss in 54%.

Abnormal CT scan results during the first month of life appear to be the best predictor of adverse neurodevelopmental outcomes. In contrast, nearly 90% of children with abnormal findings had at least one neurological abnormality.

Cerebrospinal fluid results from infected infants usually show increased protein and white cell counts. Autopsy findings reveal inflammatory infiltrates in the brain parenchyma. These changes vary greatly with age of gestation at the time of infection or virus reactivation. They also vary greatly in the degree of disability they cause in patients.

Therapy and clinical trials

National Institute of Antiviral Research Group on Allergy and infectious diseases conducted a pharmacokinetic-pharmacodynamic study that established a safe dose of intravenous ganciclovir for administration to infected newborns.

Initially, it should be recognized that the loss of observation rate was high and, therefore, the denominators for each parameter changed. However, a careful assessment of the drops indicated no bias in the analyzes. Twenty-one of 25 infants who were treated with ganciclovir and completed the study had improved hearing or continued normal auditory follow-up at 6 months, compared with 10 of 17 patients in the group who did not receive any treatment.

Secondary results showed significant short-term improvements in weight gain and head circumference in treated patients compared to controls. The treated group also had faster resolution of liver dysfunction. The primary toxicity of ganciclovir, as shown in a previous study, was neutropenia.

However, the use of ganciclovir should be limited to those children with symptomatic illness, since medicine is mutagenic, teratogenic and carcinogenic. Kimberlin and colleagues evaluated 24 infants who received 6 weeks of therapy with either intravenous ganciclovir or oral valganciclovir. Those with the highest viral loads experienced greater reductions in viral load than those with lower baseline viral loads. Valganciclovir toxicity is similar to that of ganciclovir, with 38% of subjects developing moderate to severe neutropenia.

At this time, ganciclovir and its prodrug valganciclovir are two drugs that have been shown to be effective in treating neonates for this common disorder. Their use is limited by potential toxicity, namely the induction of neutropenia, which can be especially dangerous in neonates, who are potentially more susceptible than uninfected or asymptomatic counterparts due to premature infants, intensive care units, and in the case of ganciclovir, the risks of indwelling infusion catheters medicines.

However, in order to justify the risk and effectiveness of treatment, antiviral drugs with improved toxicity profiles are needed. Ganciclovir and valganciclovir have been shown to be effective in reducing hearing loss and improving development in those treated at birth. These are not ideal medicines, however, as their use is limited by their toxicity and their inability to cure patients of the disease.

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In symptomatic children, antiviral therapy with 6-month oral valganciclovir improves hearing and nervous system outcomes. Key words: Congenital cytomegalovirus, Antiviral therapy, Valganciclovir, Vaccine, Mother-to-child transmission.

Cytomegalovirus is ubiquitous in humans and, although it usually causes asymptomatic or self-limiting infection in healthy children and adults, it is a major cause of complications in immunocompromised and congenital infants. Clinical manifestations can range from mild, transient outcomes to severe multisystem dysfunction and may include intrauterine growth restriction, petechiae, jaundice, hepatosplenomegaly, microcephaly, chorioretinitis, and sensory hearing loss.

Viral load as determined by blood polymerase chain reaction analysis may have the greatest potential in this regard, but remains to be clearly defined. Further research is needed to determine the usefulness of viral load as a predictor of outcome.

Secondary endpoints included a change in hearing from baseline to follow-up at 12 and 24 months, as well as comparisons of nervous system impairment between study groups between 12 and 24 months of age. Although there was no difference in hearing outcomes between baseline and 6 months follow-up, there was a moderate, statistically significant improvement in hearing in the 6-month group at 12 and 24 months.

As previously mentioned, the identification of a biomarker that predicts those infants who are at increased risk of persistent complications will go a long way toward developing a clinical trial of antiviral therapy for asymptomatic patients.

Any defects, including hearing and language defects, must be identified and promptly corrected with appropriate non-pharmacological intervention. In addition to these strategies, the primary goal of infection prevention is education about exposure sources and behavioral risk modification techniques to limit exposure.

Viral culture diagnostic methods are laborious and laborious, which makes universal screening using this modality unavailable for most subjects. This recombinant virus was demonstrated to be significantly attenuated in an immunocompromised guinea pig model, but it induced antibody responses comparable to wild-type infection, decreased the rate of transplacental infection, and reduced the mortality of guinea pig puppies compared to born control puppies to unvaccinated mothers.