Risk Of Fetal Or Neonatal Infection When Infection In The Mother Is Diagnosed Or Suspected

An infant born to a woman with active cervical infection with C. trachomatis is at risk of acquiring the infection during passage through the infected birth canal. Approximately 50-75% of infants born to infected women become infected at one or more anatomic sites, including the conjunctiva, nasopharynx, rectum, and vagina (Table 1). Overall, the nasopharynx is the most frequently infected site in the infant. Approximately 30-50% of infants born to Chlamydia-positive mothers will develop conjunctivitis (11-14). Studies in the 1980s identified C. trachomatis in 14-46% of infants younger than 1 month of age presenting with conjunctivitis. Chlamydia ophthalmia appears to occur much less frequently now secondary to systematic screening and treatment of pregnant women. The incubation period is 5-14 days after delivery. C. trachomatis is usually not detectable in the eye or nasopharynx immediately after birth unless there has been prolonged rupture of membranes. At least 50% of infants with chlamydial conjunctivitis also have nasopharyngeal infection. The presentation varies extremely, ranging from mild conjunctival injection with scant mucoid discharge to severe conjunctivitis with copious purulent discharge, chemosis, and pseudomembrane formation. The conjunctiva can be friable and may bleed when stroked with a swab. Chlamydial conjunctivitis needs to be differentiated from gonococcal ophthalmia in some infants, especially those born to mothers who did not receive any prenatal care, had gonorrhea during pregnancy, or abused drugs. Overlap in both incubation periods and presentation is possible.

The majority of nasopharyngeal infections in infants are asymptomatic and may persist for 3 years or more. C. trachomatis pneumonia develops in only about 30% of infants with nasopharyngeal infection. In those who develop pneumonia, the presentation and clinical findings are characteristic. Infants with C. trachomatis pneumonia usually present between 4 and 12 weeks of age. A few cases have been reported presenting as early as 2

Table 1

Selected Studies of Perinatal Chlamydial Infection

Prevalence of maternal Proportion of infants born to infected mother who developed Author (reference), year, city genital infection chlamydial infection


No. infected (%)






Frommell et al. (11), 1979, Denver








Schachter et al. (14), 1986, San Francisco


262 (4.7)






Hammerschlag et al. (13), 1989, Brooklyn


341 (8)






NP, nasopharynx; NS, not studied.

NP, nasopharynx; NS, not studied.

weeks of age, but no cases have been seen beyond 4 months of age. The infants frequently have a history of cough and congestion with an absence of fever (15,16).

On physical examination the infant is tachypneic, and rales are heard on auscultation of the chest; wheezing is distinctly uncommon. There are no specific radiographic findings except hyperinflation. A review of chest films of 125 infants with chlamydial pneumonia revealed bilateral hyperinflation; diffuse infiltrates with a variety of radiographic patterns, including interstitial and reticulonodular; atelectasis; and bronchopneumonia. Lobar consolidation and pleural effusions were not seen. Significant laboratory findings include peripheral eosinophilia (>300 cells/cm3) and elevated serum immunoglobulins (15,16).

Infants born to Chlamydia-positive mothers also may become infected in the rectum and vagina (14). Although infection at these sites appears to be totally asymptomatic, the infection may cause confusion if detected later, especially in the setting of suspected child sexual abuse. Subclinical rectal and vaginal infection may occur in as many as 14% of infants born to Chlamydia-positive women; some of these infants still were culture-positive at 18 months of age (17).

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