Congenital rubella: Congenital rubella. Rubella in newborns. Congenital rubella in newborns Child with congenital rubella epidemiological

Rubella in an infant can be congenital or acquired. A baby can become infected from a sick person through direct contact. The virus is transmitted by airborne droplets, as well as contact-household. The rubella virus is found in the mucous membranes of the upper respiratory tract, as well as in the skin. Reproduction and accumulation of infection occurs in the lymph nodes, and also spreads through the bloodstream. But infants are the least likely to get rubella from another person. If a mother is breastfeeding her child, and at the same time she had this disease before pregnancy, the baby receives the necessary antibodies through milk. The most common cause of this disease in a newborn baby is intrauterine infection. If the mother was infected with this virus during pregnancy, then there is a high probability of rubella in the baby.

Symptoms

If the baby was born with the presence of this virus in the body, then the following symptoms will appear:

Deafness;
Sluggish state of the child;
White pupil or cloudy cornea;
developmental delay;
Light body weight;
Epilepsy attacks and increased nervous excitability;
The small size of the head, and as a result - the brain;
Rash on the skin.

If a newborn baby becomes infected with rubella after birth, the signs of the disease will be different. The most pronounced symptom of an infection in the body is a rash on the surface. Initially, spots appear on the face, but over time, the body becomes covered with a rash. The sizes of the spots do not exceed 5 mm and are round in shape, and also do not merge like measles rashes. The rash is not extensive, and there may be some redness in certain areas of the body and face. In addition to the red rash, the baby shows other signs:

Increase in body temperature up to 38 degrees. But usually the temperature fluctuates between 37.3-37.6 degrees throughout the entire period of the disease.
Up to the size of a pea, the lymph nodes are enlarged, which are well palpable. They continue to be in this state after recovery and the disappearance of the rash for some time.
The oral mucosa becomes inflamed, the tonsils become loose. Small pale pink spots form on the mucous membrane of the soft palate.
There is a runny nose and dry cough, but minor. Runny nose and cough may appear 1-2 days before the rash appears
The appearance of conjunctivitis and increased lacrimation. Conjunctivitis is mild, without the appearance of purulent discharge;
The baby feels unwell, eats and sleeps poorly.

Diagnosis of rubella in a newborn

Rubella can be diagnosed with the help of tests and examination of the baby. A blood test is taken from a baby with suspicion of congenital and acquired rubella. In the presence of the virus in the blood, there is a decrease in leukocytes and the appearance of plasma cells. In addition to tests, rubella can be determined by external signs and general symptoms. Therefore, the doctor can easily recognize the presence of infection in the baby's body and make a diagnosis.

Complications

Congenital rubella is dangerous for many severe consequences of the development of the child's body. Due to the virus, there is a violation in the development of many organs, including the central nervous and cardiovascular systems. Complications in infants who become infected with rubella after birth are very rare. As a complication, rubella encephalitis, an inflammation of the brain, can occur. The most rare occurrence is thrombocytopenic purpura. This is increased bleeding in the body due to a decrease in the number of platelets.

Treatment

What can you do

The first aid that a mother can provide if a newborn child is suspected of being infected with rubella is to call a doctor. But if the temperature rises above 38-38.5 degrees, it is necessary to give the baby an antipyretic. The main treatment is prescribed by the doctor after examination and obtaining the results of the tests. With a mild course of the disease, hospitalization of the infant is not required. For a newborn infected with a virus, a sufficient intake of fluid into the body is necessary, which must be provided by the mother. When breastfeeding, milk is a good substitute for water, so the mother can feed the baby more often than usual.

What does a doctor do

The main treatment for congenital rubella is currently not fully developed. Doctors prescribe therapy using drugs containing recombinant interferon. In addition, doctors with the help of various medications restore the functioning of the affected organs of the baby. For infants who were infected with rubella in utero, regular examinations by doctors of various specializations are necessary. For children who become infected with rubella after birth, complex treatment is prescribed to eliminate symptoms. Antihistamines, antipyretic drugs are prescribed. To reduce the lymph nodes, the infant must undergo a course of UHF therapy. If necessary, the doctor may prescribe the intake of vitamin complexes.

Prevention

To prevent congenital rubella in a baby, the expectant mother needs to be vaccinated before pregnancy. If vaccination has not been carried out, then she needs to be in crowded places as little as possible, wash her hands more often. A healthy newborn baby must be protected from infection in the same way. Since the rubella vaccine is given after 1 year, until this time it is necessary to monitor the environment of the baby. If someone in the family has contracted the virus, it is necessary to protect the baby from communicating with this person until he fully recovers. And household items through which a baby can become infected should preferably be treated with hydrogen peroxide.

Toddlers of any age can easily become infected with rubella. The infection spreads very quickly from a sick child to a healthy one. It can be especially unfavorable in infants, as well as from the first days of life.

Reasons for the appearance

The culprit in the onset of the disease in babies is the rubella virus. It is quite small and penetrates well through various biological barriers. Even during pregnancy a woman who gets rubella infection can infect her unborn baby through the placenta.

In this case, there is congenital form of rubella. It occurs quite rarely. However, in newborn babies, the disease can be relatively severe. Babies are already contagious from birth. Rubella viruses can remain in their blood for quite a long time. The child remains contagious for several months.

Breastfed babies also often develop rubella. This is often the mother's fault.

If a woman becomes ill during lactation, then through breast milk she can infect her baby.

Rubella viruses easily penetrate the bloodstream, rapidly spreading throughout the body. A few hours after the microbe enters the mother's body, they are already in the milk. Even 6-month-old babies who are already receiving complementary foods can also easily become infected.

Babies do not get sick immediately, but after the incubation period. During this time, viruses actively multiply and begin to spread throughout the body, penetrating into the blood vessels and internal organs. The usual incubation period for rubella in infants is 3 weeks. In newborn babies, this period can be reduced to 14 days.

During the incubation period, babies are practically not bothered by anything. It is quite difficult to suspect the disease at this stage. Some babies may have a fever. However, quite often it rises to a maximum of 37 degrees. Rarely, there is a slight congestion when breathing. This feature is optional and does not always occur.

The behavior of the child practically does not suffer. Kids actively eat, habitually play with toys, smile. After the end of the incubation period, a period of skin manifestations begins, which, with rubella, manifests itself quite clearly.

Main symptoms

The classic manifestation of rubella infection is a rash. The first elements on the skin appear approximately 2-3 weeks after infection.

Rubella rash has the following specific features:

It first appears on the scalp, neck and upper body. On the head, skin rashes are quite poorly visible if the baby is already growing hair. However, in newborn babies, red spots are well distinguished.
Spread from top to bottom. Over the next day from the moment the first appearance of red spots, the rash begins to appear on the whole body (in a downward direction). Very quickly spots appear on the back, abdomen, legs.
There is no itching. All rubella spots do not itch. Toddlers do not comb the spots, often they do not even feel them. The child is practically not bothered by anything, but the condition itself can be painful.
The highest concentration of elements on the inner surface of the forearms and thighs, as well as on the buttocks. This sign is associated with the peculiarities of the blood supply to these zones. In these places, the elements can merge with each other, whimsical patterns or drawings appear.
All spots rise above the surface of the skin. When probing, a rubella rash can be distinguished from healthy skin. The elements protrude above the skin surface by a couple of millimeters.
Absence of red spots on the palms and soles. This is one of the characteristic signs of the disease. The only areas where rubella elements do not appear (due to the structural features of the child's body) are the inner surfaces of the palms and feet.
The gradual disappearance of the rash without disfiguring scars or scars. In place of the former red spots, only a slight peeling remains, which passes very quickly (without the use of special ointments or creams). The last spots disappear on the legs and the inner surface of the handles.

Usually the disease proceeds in a classic or typical variant. In this case, the sick child will definitely develop a rash.

However, in 30% of children, the disease can proceed in an atypical variant. In this case, there is no rash, but there are other signs of rubella infection. In such babies, after two to three weeks from the moment of infection, the lymph nodes begin to increase greatly.

The most severely damaged nodes in the back of the head. When examining the neck, large tubercles are visible. When feeling, you can determine the lymph nodes enlarged up to 1-2 cm. Nodes may increase in the lower jaw, in the armpits or in the groin. With such an atypical variant of the disease, a doctor's consultation is required.

Children with rubella infection are prescribed for therapy:

Mandatory bed rest. Toddlers in the first year of life and babies should sleep at least 10 hours a day. During such a rest, the children's body recovers faster and gains strength to further fight the infection.
Medical nutrition. Breastfeeding is not canceled if the mother is vaccinated or had a rubella infection in childhood. In other cases, it is possible to switch to adapted mixtures for the entire acute period of the disease. Babies who receive complementary foods choose dishes with a more liquid consistency. An excellent choice would be mashed vegetable or fruit puree. Porridge or meat dishes are chosen as the main complementary foods. For babies older than 10 months, fermented milk products can be used.
Drink. To quickly remove all bacterial toxins from the body, the baby should be given more water. You can drink any warm boiled water. For babies from 6 months, you can add fruit juice. It is better to choose a drink from green apples or pears. For older children, you can cook fruit or berry juice, as well as compote. Rosehip decoction is prepared for children older than one year.
Compliance with hygiene rules. To prevent infection of other family members, the child must have his own dishes, towels and personal hygiene products. Wash textiles at least 2-3 times a week. If there are several kids in the family, toys should be treated with special disinfectants.

Rubella infection can be quite a dangerous disease for newborns and infants. Knowledge of the main clinical manifestations of the disease will help mothers to suspect rubella in a child in time and seek medical help. Timely treatment under the supervision of a doctor will certainly lead to a full recovery.

congenital rubella

V.V. Zverev, R.G. Desyatskov
Research Institute of Viral Preparations named after O.G. Andzhaparidze RAMS Moscow

Rubella, known for over 200 years, has been considered a mild illness in children for many decades. Attitudes towards this disease have changed dramatically since, in 1941, the Australian ophthalmologist N. Gregg first established the etiological relationship between rubella in women in early pregnancy and multiple malformations (congenital cataracts, heart defects, deafness - Gregg's classic triad) in children born to these mothers. (Gregg N.M., 1941, 1956). N. Gregg's report marked the beginning of studies of the teratogenic role of rubella in human pathology and the search for the causative agent of this infection.

The rubella virus was isolated in 1962 simultaneously by two groups of American researchers: T. Weller, F. Neva (Boston) and P. Parkman, E. Busher, M. Artemstein (Washington). The social significance of the rubella problem became apparent during the pandemic that took place in 1963-1965. The epidemic in the United States in 1964-1965 was especially severe in its consequences, with which the birth of about 30 thousand children with congenital rubella syndrome (CRS) is associated. As a result of intensive clinical, epidemiological and virological studies, the classic Gregg syndrome was supplemented with a description of other manifestations of intrauterine rubella infection and information on the impact of rubella on the course of pregnancy in general. Congenital rubella syndrome may include congenital anomalies of the organs of vision (cataract, glaucoma, retinopathy, chorioretinitis, microphthalmos), malformations of the cardiovascular system (non-closure of the ductus botalis, stenosis of the pulmonary artery orifice, defects in the interventricular and interatrial septum, myocarditis), malformations of the organs of hearing, hepatosplenomegaly , pneumonia, lesions of the central nervous system (microcephaly, encephalitis, hydrocephalus, mental retardation), digestive and genitourinary systems, lesions of long tubular bones. Other manifestations include thrombocytopenia, anemia, malnutrition, lag in physical development.

SVK is characterized by multiple lesions. Thus, in 75% of cases of CRS, a combination of two or more developmental defects occurs.

Intrauterine infection often leads to spontaneous abortions and stillbirths (up to 40% with infection in the first 8 weeks of pregnancy). The frequency of CRS in children whose mothers had rubella in the first months of pregnancy varies, according to different authors, from 15.9% to 59%. On average, CRS is diagnosed in 20-25% of these newborns. During the observation during the first two years of life of children infected in the first trimester of their intrauterine development, 85% of them had a pathology of a different nature.

It has been established that late complications such as panencephalitis, diabetes mellitus and thyroiditis can occur in congenital rubella. CRS accounts for about 10% of the total number of congenital anomalies. Congenital rubella results from primary rubella infection in pregnant women. Inapparent infection poses the same teratogenic danger to pregnant women as manifest infection.

In the pathogenesis of congenital rubella, viremia in the mother and infection of the placenta, leading to necrotic changes in the latter, are of paramount importance, which contributes to the penetration of the virus into the fetus. Widespread dissemination of the virus is expressed in the early stages of pregnancy. Congenital rubella is characterized by a chronic form of infection, accompanied by prolonged persistence of the virus. In this case, the virus is isolated with high frequency from various organs of the fetus. Among children with congenital rubella under the age of one month, the virus is isolated from the discharge of the nasopharynx, conjunctiva, as well as intestines, urine and cerebrospinal fluid in 84% of the examined, by the end of the first year of life - in 11%.

The direct action of the rubella virus is associated with its cytolytic activity in some tissues, with its ability to damage chromosomes and inhibit the mitotic activity of infected cells. In addition, when an embryo or fetus is infected, the rubella virus has an immunosuppressive effect, leading to inhibition of interferon production and inhibition of cellular immunity.

Congenital rubella manifests itself with varying frequency depending on the gestational age at which the woman's disease occurs. Rubella is most dangerous in the first three months of pregnancy. A particularly high frequency of lesions was noted during infection in the first 4 weeks of pregnancy, accounting for 60.9% of cases of CRS, in the second month - 26.4% and in the third - 7.9%. The determination of certain developmental defects that occur with rubella at different stages of pregnancy depends on the period of embryo development: the brain - at 3-11 weeks, the organs of vision and heart - at 4-7 weeks, the organ of hearing - at 7-13 weeks , sky - at 10-12 weeks.

With intrauterine infection at a later date: between 13-17 weeks, retinopathy and deafness may occur in 15-17%. With rubella, which complicates pregnancy after the 16th week, developmental defects are rare, but sensory organs can be affected and such severe complications from the nervous system as meningoencephalitis can develop.

The immune response in congenital rubella has a number of characteristic patterns. If the mother had rubella during pregnancy, but the fetus was not infected, then maternal IgG antibodies are transmitted to the fetus from 12-16 weeks, while maternal IgM antibodies usually do not pass through the placenta. Passive IgG antibodies disappear in a child within 6-10 months after birth. In cases where intrauterine infection has occurred, in the infected fetus, along with the appearance of maternal IgG antibodies, at 16-24 weeks of development, their own virus-specific IgM antibodies begin to be produced, which can persist in a child with congenital rubella for a long time after birth - up to 6 months, and in some cases up to a year or more. From the second half of the first year of life in children with congenital rubella, specific IgG antibodies begin to be produced. Significantly, the low avidity of these antibodies has been proven.

The problem of rubella and its teratogenic danger is relevant in Russia, as well as in many countries of the world.

In the course of seroepidemiological studies carried out in the Russian Federation since 1964, reliable data have been obtained on the wide spread of infection in different age groups, on susceptible contingents, in particular, among women of childbearing age. It has been established that most of the population suffers from rubella at preschool age (60-80%). The number of women of childbearing age who do not have rubella antibodies in different regions varied from 1% to 31% and averaged 11%. Along with this, the spread of rubella infection among pregnant women in the manifest and inapparent forms in the ratio of 2.36:1 was established. Among children, this ratio was 1:1.4. In foci of serologically confirmed infection, the incidence of rubella among susceptible pregnant women was 34.6%.

Annual incidence rates in the Russian Federation, recorded since 1978, varied until 2003, ranging from 98.2 to 407.1 per 100,000 population. There have been periodic rises in incidence every 4-5 years. For the period 1997-2001. morbidity rates have doubled compared to the previous 5 years. It is known that during epidemics the threat of infection of pregnant women increases by more than 20 times. Based on WHO data, according to which the number of CRS cases is 0.13% of the total number of diseases, it can be calculated that up to 450 children with rubella etiology malformations are born annually in a country where from 150 thousand to 500 thousand rubella patients are registered. .

Direct evidence of the teratogenic effect of the rubella virus circulating among the country's population has been obtained. Prospective studies revealed developmental defects (cataracts, eyelid adhesions, absence of one hemisphere of the brain) in 6 (38%) of 16 examined children from mothers with rubella. When examining another 18 children, 6 (33.3%) were diagnosed with cataracts.

Among children with congenital defects, the incidence of CRS was 8.1%. Children who were serologically confirmed to have intrauterine rubella had congenital heart defects, cataracts, hepatosplenomegaly, CNS lesions, microcephaly, thalamic calcifications, malnutrition, deafness, and impaired psychomotor development. At the same time, a combination of several malformations was noted in 34.1% of children with confirmed congenital rubella.

According to available information, the frequency of congenital rubella among children with congenital pathology can reach even higher rates - 15-35%. In children with congenital rubella, CNS lesions were most often detected (82.3%).

The final diagnosis of congenital rubella is made on the basis of an analysis of data from clinical, epidemiological and laboratory studies. In the presence of clinical signs of intrauterine rubella, laboratory confirmation of this infection is the isolation of the rubella virus, the detection of high levels of antibodies to the virus and the detection of specific IgM in the first half of the child's life; in the second half of the year - detection of high levels of virus-specific antibodies and low-avid IgG antibodies to the rubella virus. In the absence of laboratory confirmation of the diagnosis, the clinical diagnosis of CRS is based on the identification of any two of the main symptoms (cataract or congenital glaucoma, congenital heart disease, deafness, retinopathy pigmentosa) or a combination of one of these main symptoms and one of the additional symptoms (purpura, splenomegaly, jaundice, microcephaly, meningoencephalitis, bone changes and mental retardation).

Children with congenital rubella should be treated in a hospital. Depending on the activity of the current infection, treatment is carried out with recombinant interferon preparations and interferonogens. Treatment of malformations is carried out in specialized hospitals, where their correction and rehabilitation measures are carried out.

The economic damage from rubella in the Russian Federation in 2001 alone amounted to 1.3 billion rubles.

According to American researchers, the cost of maintaining and educating children with congenital cataracts, deafness, mental and physical disabilities is more than 200 thousand dollars per child throughout his life.

The measures of non-specific prevention of rubella and its teratogenic consequences include the exclusion of contacts between pregnant women and patients with rubella, timely and accurate diagnosis of rubella in sick pregnant women with suspected rubella, deciphering the etiology of foci of exanthemic diseases where pregnant women were, determining the immune status, serological surveillance of non-immune (susceptible) ) persons.

The most effective way to protect against acquired and congenital rubella is immunization of the population with live attenuated rubella vaccines.

In the Russian Federation, immunization against rubella was introduced into the National Compulsory Immunization Schedule by Order of the Ministry of Health of the Russian Federation No. 375 dated 12/18/1997. According to the calendar, children of both sexes are vaccinated. The first vaccination is carried out at the age of 12 months, the second - revaccination - at the age of 6 years. In addition, 13-year-old girls who have not been vaccinated before or who have received only one vaccination are vaccinated.

At the 48th session of the WHO Regional Office for Europe in 1998, rubella was included among the infections to be controlled by the objectives of the Health for All in the 21st Century program. WHO/Europe has declared one of the goals of the Health program by 2010 or earlier to reduce the incidence of CRS to below 0.01 per 1000 live births.

Literature

Anjaparidze O.G., Chervonsky G.I. Rubella, M., Medicine, 1975, p. 102.
Desyatskova R.G. et al., in the book. Rubella. Syndrome of an inborn rubella, Inf. Sb., 1997, p. 17-24.
Kantorovich R.A., Volodina N.I., Teleshevskaya E.A. et al., WHO Bulletin, 1979, 57(3), p. 445-452.
Kantorovich R.A., Teleshevskaya E.A., Karazhas N.V. et al., Questions of Virology, 1981, 3, p. 327-332.
Nisevich L.L., Bakhmut E.V., Talalaev A.G. etc. In the book. Rubella. Syndrome of an inborn rubella, Inf. Sb., 1997, p. 31-39.
Semerikov V.V., Lavrentieva I.N., Tatochenko V.K. et al. Rubella, 2002, p. 174.
Tatochenko V.K. In book. Rubella. Syndrome of an inborn rubella, Inf. Sb., 1997, p. 24-31.
Uchaikin V.F., Sluchenkova L.D., Shamsheva O.V. In book. Rubella. Syndrome of an inborn rubella, Inf. Sb., 1997, p. 39-45.
Fitzgerald M.G., Pullen G.R., Hosking C.S., Pediatrics, 1988, 81, 812-814.
MacCallum F.O. Proc. Roy. soc. Med., 1972, 65, 7, 585-587.
Miller E., Gradock-Watson J.E., Pollok T.M. Lancet, 1982, 2, 781-784.
Parkman P.D. Clin. Infect. Dis., 1999, 28 (Suppl 2), 140-146.
White C.C., Koplan J.D., Orestein W.A., Am. J. Publ. Health, 1985, 75(7), 739-744.

© V.V. Zverev, R.G. Desyatskova, 2004

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Definition

congenital rubella - a disease of a viral nature in children infected in the womb before birth, as a result of the transmission of the pathogen from an infected mother through the placenta.

Causes and risk factors

Congenital rubella is caused by the destructive effect of the rubella virus on the fetus at critical moments in fetal development. The fetus is most vulnerable in the first trimester of pregnancy (the first 3 months of pregnancy). After the fourth month of pregnancy, the risk of rubella transmission from mother to fetus is less, but the disease can still develop.

The incidence of congenital rubella has dropped dramatically since the introduction of the rubella vaccine in women planning pregnancy.

Risk factors for a child to become infected with rubella:

the woman did not have rubella before pregnancy
the doctor did not recommend the woman to be vaccinated against rubella at the stage of pregnancy planning
the pregnant woman was in contact with a patient with rubella (with obvious or hidden symptoms)

Pregnant women who have not been vaccinated against rubella and have not previously had rubella enter the very high risk (!) disease and potential danger to their unborn child.

Symptoms of congenital rubella in a newborn

Symptoms of congenital rubella in a newborn:

cloudy cornea or white pupil
deafness
intrauterine growth retardation
general lethargy of the child
increased nervous excitability
low birth weight
mental retardation
epileptic seizures
microcephaly - small head and brain size
specific skin rash at birth

Diagnostics

If a newborn is suspected of having congenital rubella, blood is taken immediately after birth to determine the level of antibodies to rubella, conduct a general blood test, and biochemical studies. They also do a general urinalysis, if necessary - cerebrospinal fluid, TORCH-screening.

Treatment of congenital rubella

No specific treatment for congenital rubella has been developed to date. Therapeutic measures are aimed at restoring the function of organs and systems affected by the rubella virus, conducting regular examinations by relevant specialists (pediatrician, neuropathologist, ophthalmologist, infectious disease specialist).

Forecast

The consequences of congenital rubella for a child depend on the severity of the disease and the time of infection. The treatment of heart defects, which are often caused by the rubella virus, is carried out surgically. Violations of the function of the nervous system are difficult to correct and are permanent.

Complications of congenital rubella

Complications of congenital rubella can be associated with damage to several organs and systems:

cataract
glaucoma
chorioretinitis

open ductus arteriosus (ductus arteriosus)
pulmonary stenosis
other heart defects (tetrad, triad, pentad of Fallot, open foramen ovale, etc.)

Central nervous system:

mental retardation
lag in physical development
small size of the head and brain - microcephaly
encephalitis - inflammation of the brain tissue
meningitis - inflammation of the lining of the brain

deafness – the rubella virus attacks the auditory nerve and structures of the inner ear
thrombocytopenia - a low number of platelets in the blood
enlarged liver and spleen
muscle hypertonicity
developmental disorders of the skeletal system

Contacting a doctor

Call your doctor if:

you have doubts about the presence of congenital rubella in a child
you do not know if you have had rubella before
you have not been ill and not vaccinated, but you are planning a pregnancy
you have been in contact with a person with rubella (even before the onset of the first symptoms)

Note!

Rubella vaccination before pregnancy at the planning stage significantly reduces the risk of rubella infection in women and the transmission of the virus to the fetus.

Pregnant women who are not immune to rubella should avoid contact with persons who may be infected. Rubella virus carrier does not exist! Rubella is an acute infection, you can get sick with it only once in your life, and you can carry antibodies to the virus all your life (IgG).

- a viral disease transmitted from an infected mother to a child in the prenatal period. Infection of a woman occurs during pregnancy or before it. The disease is manifested by multiple internal malformations and defects in the development of the fetus, mainly damage to the organs of vision and hearing, as well as the cardiovascular and nervous systems. In most cases, it manifests itself from the first days of life, but later detection of symptoms is also possible. It is diagnosed from the moment of birth by special laboratory tests and clinically (according to the above symptoms). There is no specific treatment, interferon and symptomatic therapy are used.

Congenital rubella is a contagious disease. This means that a child diagnosed by a pediatrician can transmit the virus to others. The disease got its name in 1740 from one of the common symptoms - thrombocytopenic purpura. F. Hoffman was the first doctor to describe the disease. However, more than two hundred years passed before congenital rubella began to cause serious concern, since it was in the second half of the twentieth century that the causative agent of the infection was identified. At the same time, a connection was found between a woman's illness during pregnancy and pathologies of the newborn.

Among other features, the high prevalence of infection in countries with a temperate climate and seasonality should be noted. The peak incidence occurs in spring and autumn. Major epidemics occur every 6-9 years, with a higher incidence among the unvaccinated population. For this reason, pediatrics is the first and most important clinical discipline in the prevention of congenital rubella. It is in the first years of life that children receive the rubella vaccine, which makes it possible to avoid infection in adulthood, in particular, during pregnancy in women.

Statistics show that congenital rubella accounts for up to 10% of all congenital pathologies. When a woman and fetus are infected in the first weeks of pregnancy, spontaneous abortion occurs in 40% of cases. In 75% of cases, multiple organ lesions (two or more defects) are noted. Recent statistics indicate that the incidence is steadily increasing.

Causes of congenital rubella

The only cause of infection is the rubella virus, isolated by American scientists in 1961. It is an RNA virus and belongs to the Togavirus family. Infection occurs in the prenatal period, when the pathogen from an infected mother passes through the vessels of the placenta, entering the blood of the fetus. The risk of infection depends on when the expectant mother fell ill. If a woman suffers an infection in the first trimester of pregnancy, then in 60-90% of cases, the child will be diagnosed with congenital rubella. In the second trimester, the risk decreases to 10-20% of cases. Towards the end of pregnancy, the risk of infection of the fetus increases again due to the weakening of the placental barrier. Women who have not been vaccinated before are at greater risk.

Passing through the vessels of the placenta, the causative agent of congenital rubella enters the blood of the fetus, where it has a teratogenic effect. It acts directly on the genetic apparatus of the cell (chromosomes), slowing down the growth and development of organs, which is why multiple malformations are associated. Along the way, the virus destroys the small vessels of the placenta, which leads to a deterioration in placental blood flow. Lack of proper nutrition and chronic fetal hypoxia also contribute to slowing down the development of the child. In the lens of the eye and the cochlea of the inner ear, the virus has a direct cytodestructive effect, that is, it destroys cells. The earlier the infection occurred, the more serious the symptoms of congenital rubella will be, since it is in the first weeks of pregnancy that the laying of the main systems occurs: first the organs of vision, then the organs of hearing, the cardiovascular and nervous systems, etc.

Symptoms of congenital rubella

Back in 1942, N. Gregg identified three main signs of congenital rubella: damage to the organs of vision (most often congenital cataracts), deafness and heart defects. Symptoms are usually observed immediately after the birth of a child, less often congenital rubella manifests itself after a few years. It's about mental retardation. The severity of clinical manifestations depends on the gestational age at which the infection occurred. Therefore, in practice, the classical triad of N. Gregg's symptoms does not always take place, and if they are presented in aggregate, then the violations may not be so gross.

Among congenital heart defects, aortic valve damage, aortic stenosis, atrial and interventricular septal defects are common. This causes severe circulatory failure, due to which all internal organs are underdeveloped to one degree or another. Damage to the nervous system can be manifested by microcephaly, hydrocephalus, there are cases of meningoencephalitis, paralysis and convulsions, and impaired consciousness. Cataracts, glaucoma, microphthalmia are most likely when infection occurs in the first weeks of pregnancy. Skeletal malformations, such as osteoporosis, hip dysplasia, syndactyly, are also often detected. Malformations of the genitourinary and digestive systems are less common.

The main symptoms of congenital rubella also include thrombocytopenic purpura, the cause of which is vascular disorders and changes in the blood of a sick child. Visually, purpura looks like a bright red rash all over the baby's body. The rash usually resolves without treatment within a couple of weeks after birth. A non-specific symptom is prolonged jaundice of the newborn, associated with insufficient development of internal organs and the inability to utilize excess bilirubin in the blood, as is normal. Outwardly, the newborn usually looks slightly inhibited. This is primarily due to damage to the visual and auditory apparatus, but neurological disorders also play a role here.

The outcome of the disease directly depends on its severity. In severe cases, the life expectancy of sick children is several years. As a rule, death results from heart and vascular defects (stenosis of the aorta and pulmonary artery, open ductus arteriosus), microcephaly, hydrocephalus, meningoencephalitis, hepatitis, bone diseases, severe thrombocytopenia, the addition of various infections due to low immunity, etc. Congenital rubella is considered completely cured when the virus is no longer detectable in the blood. After the disease, a strong immunity is formed.

Diagnosis of congenital rubella

The first stage is early prenatal diagnosis, that is, the detection of a disease in a pregnant woman. This is done by an infectious disease specialist and an obstetrician-gynecologist who observes a woman during pregnancy. Once the diagnosis is confirmed, the likelihood of a child developing congenital rubella can be assessed. The expectant mother has the opportunity to make an informed decision about carrying a child or an artificial termination of pregnancy, taking into account all medical indications. The risk of developing the disease in a child depends on the duration of pregnancy and reaches 60-90% in the first trimester.

After childbirth, congenital rubella is preliminarily diagnosed clinically, that is, according to the main symptoms. Doctors pay attention to the simultaneous damage to the organs of vision and hearing. First, during the physical examination, the neonatologist will find that the baby does not respond to bright lights in the delivery room and does not turn his head towards the source of the sound. You can also immediately suspect heart defects. Sometimes neurological signs are externally noted: muscle tone disorders, microcephaly, hydrocephalus, symptoms of meningism, etc. A bright red rash is noticeable from the first days of life.

Congenital rubella is confirmed by laboratory tests. The diagnosis is considered reliable after the detection of specific IgM antibodies in body fluids: urine, blood, cerebrospinal fluid. Most often, urine and a smear from the nasopharynx are analyzed. ELISA diagnostics allows to detect antibodies. Laboratory studies help distinguish congenital rubella from many diseases with similar symptoms, such as cytomegalovirus infection, toxoplasmosis, Epstein-Barr virus, and some others.

For the diagnosis of heart defects, ECG and EchoCG are performed, hearing and vision impairments are clarified and confirmed by narrow specialists - an ophthalmologist and an otorhinolarynologist. Be sure to follow up with a pediatric neurologist from birth. Even if neurological disorders are not detected from the first days of life, they very often appear later, even after several years. At the same time, a psychiatrist can join the therapy, since mental retardation is inevitable - from mild cognitive disorders to oligophrenia of varying severity.

Treatment of congenital rubella

Therapy is carried out exclusively in a hospital setting. Since congenital rubella is of a viral nature, drugs that increase antiviral immunity, namely interferon, are involved in the treatment. Everything else is the fight against the symptoms of the disease.

Rehabilitation measures are aimed at compensating or eliminating concomitant diseases of internal organs. Heart defects are most often operable and correctable. Hearing and visual impairments are eliminated as much as possible. Intrauterine brain damage is not treatable, the doctor can only correct intracranial pressure, convulsions, if any, but a complete cure is impossible. These measures can significantly improve the quality of life of a sick child. At the same time, social adaptation is also carried out, since the transferred congenital rubella makes the child disabled, and also affects his mental development.

Forecast and prevention of congenital rubella

The prognosis depends entirely on the severity of the disease, which is determined by the duration of infection of the fetus and the symptoms present. In severe cases, life expectancy is several years. If the organs of vision and hearing are little affected, in the future, congenital rubella will manifest itself only as a developmental delay and neurological disorders.

Prevention is closely related to the early diagnosis of rubella in a pregnant woman. In the first trimester, it is recommended to terminate the pregnancy due to the high risk of infection of the fetus and the most severe clinical manifestations in case of infection. Mortality among these children remains high. Another effective way to prevent congenital rubella is vaccination. In children, it is carried out in the first years of life. Rubella vaccination is mandatory in the National Immunization Schedule. For adults, especially women of reproductive age, booster immunization is recommended every 10 years.

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