Perinatal Infection Control And Mother-To-Child Transmission

Perinatal infection control protects parents, babies and healthcare workers during the period from pregnancy through birth and the early weeks of life. It combines screening, vaccination, treatment, safer clinical practice, careful feeding advice and reliable follow-up. The aim is to prevent an infection from passing from a pregnant person to their baby before birth, during labour or through breast milk.

This work requires coordination between families, midwives, obstetricians, neonatologists, GPs, infectious disease specialists and public health teams. The scientific discussions planned for FAOPS 2020 and PREBIC AA 2020 in Tokyo reflected the international importance of perinatal and neonatal medicine. Although the congress was cancelled in April 2020 because of COVID-19 and international travel restrictions, its central concerns remain relevant to Australian maternity and newborn services.

Understanding Transmission During The Perinatal Period

Infections can reach a baby through several routes. Some cross the placenta during pregnancy, including congenital syphilis, cytomegalovirus, toxoplasmosis, rubella and, in some cases, parvovirus. Others are transmitted through exposure to blood or genital secretions during labour, as can occur with hepatitis B, hepatitis C, HIV, herpes simplex virus, gonorrhoea or chlamydia.

A newborn may also acquire infection after birth through close contact, feeding or an unrecognised exposure in hospital or the community. Group B streptococcus is a significant example because it may cause severe early-onset disease shortly after delivery. Prevention therefore needs to begin well before labour and continue through neonatal observation, testing and early treatment when indicated.

Risk is shaped by more than a positive test result. Viral load, timing of infection, vaccination status, treatment response, membrane rupture, mode of birth and the baby’s gestational age can all matter. Clear documentation and communication are essential, particularly when care is transferred between a birth centre, a regional hospital and a tertiary neonatal unit.

Screening And Care Before Birth

Routine antenatal screening gives clinicians an opportunity to identify infections early and reduce the chance of congenital or neonatal disease. Australian maternity services commonly offer testing for HIV, syphilis, hepatitis B and hepatitis C, with additional investigations guided by symptoms, medical history, travel, exposure or local policy. Repeat testing may be appropriate when a person has ongoing risk or presents later in pregnancy.

Vaccination is another key prevention measure. The Australian National Immunisation Program supports maternal protection against influenza and pertussis, while COVID-19 vaccination advice is updated as evidence and public health guidance develop. Immunisation during pregnancy can protect the pregnant person and provide antibodies to the newborn. Vaccines containing live organisms, such as measles, mumps and rubella, are generally considered before pregnancy or after birth rather than during pregnancy, so preconception care remains valuable.

Treatment should be timely, accessible and culturally safe. Syphilis requires particular vigilance because rates have risen in some Australian communities, including remote areas. Aboriginal Community Controlled Health Services can provide trusted, locally appropriate care, while referral pathways must ensure that testing and treatment are not interrupted by distance, transport problems or changes in healthcare provider.

Safer Birth Practices And Clinical Decisions

When an infection is identified, the birth plan should be individualised rather than based on a single diagnosis. For example, effective antiretroviral treatment and a low viral load can substantially reduce HIV transmission, while hepatitis B prevention relies heavily on prompt newborn vaccination and immunoglobulin when indicated. With active genital herpes lesions or prodromal symptoms at labour, a caesarean birth may be recommended to reduce exposure.

Infection prevention in the birth suite includes hand hygiene, appropriate personal protective equipment, safe handling of sharps and careful cleaning of reusable equipment. These measures protect against recognised and unrecognised infections. They should be applied respectfully, without isolating or stigmatising families unnecessarily.

Antibiotic use also needs discipline. Intrapartum antibiotics can prevent early-onset group B streptococcal disease when a pregnant person is colonised or has relevant clinical risk factors. However, broad-spectrum antibiotics should not replace testing, clinical assessment or antimicrobial stewardship. Local hospital protocols in Sydney, Melbourne, Brisbane and smaller regional centres may differ in detail, so clinicians should follow current state and national guidance.

Protecting Newborns After Delivery

Newborn prevention begins immediately after birth. Babies exposed to hepatitis B may require vaccination and hepatitis B immunoglobulin as soon as possible, ideally within the first 12 hours. Infants born to people with HIV need specialist-directed antiretroviral prophylaxis and follow-up testing. A baby exposed to syphilis, herpes or other infections may require examination, blood tests, imaging or treatment even when they initially appear well.

Observation is particularly important for premature and low-birth-weight infants. Their immune systems are immature, and early symptoms may be subtle. Poor feeding, temperature instability, lethargy, respiratory distress, jaundice or changes in tone should be assessed promptly rather than attributed automatically to normal newborn adjustment.

Parents need practical information in plain language. They should know which symptoms require urgent medical review, how follow-up testing will be arranged and whether household contacts need vaccination or assessment. In Australia, families may move between a public hospital, a private obstetrician, a GP and a child and family health nurse, so discharge summaries and shared electronic records can prevent missed care.

Feeding, Human Milk And Infection Risk

Breast milk provides important nutrition and immune factors, but recommendations depend on the infection involved. For some conditions, breastfeeding is encouraged with appropriate maternal treatment. For others, temporary interruption, expressed milk, pasteurised donor milk or formula may be advised. HIV, active untreated tuberculosis, certain medications and specific viral infections require specialist guidance rather than a general rule.

Expressing and storing milk safely can reduce contamination risk. Families should wash hands, use clean equipment, label containers and follow the storage instructions provided by their maternity or neonatal service. In neonatal intensive care, screened donor milk may be used when a parent’s own milk is unavailable or insufficient. Information about human milk banks is especially relevant to discussions about donor screening, pasteurisation and equitable access.

Australia has established human milk banking services, including programs linked with neonatal units in states such as New South Wales and Queensland, although availability is not uniform. A family in inner Melbourne may have different access from one living in the Northern Territory or a remote Western Australian community. Safe feeding plans should therefore account for local supply, transport, refrigeration and the baby’s clinical needs.

Practical Recommendations For Maternity Services

Effective prevention depends on consistent systems as much as individual clinical decisions. Services should audit screening completion, vaccination rates, treatment intervals, newborn prophylaxis and follow-up attendance. They should also examine whether Aboriginal and Torres Strait Islander families, migrants, refugees and people living in rural areas experience avoidable barriers.

Useful actions include:

• Offer clear preconception and antenatal screening, with repeat testing based on clinical risk and current Australian guidance.
• Record infection results, treatment dates, vaccination history and newborn plans in a format visible to every relevant care team.
• Provide culturally safe education through interpreters, Aboriginal health workers and community-based services where appropriate.
• Use standard birth-suite procedures for hand hygiene, equipment cleaning, personal protective equipment and antibiotic stewardship.
• Arrange documented neonatal follow-up before discharge, including testing, immunisation and specialist review when required.

Communication should continue after the family leaves hospital. A follow-up call, GP appointment or child and family health review can identify missed doses, feeding concerns or early symptoms. Services should also make transport and telehealth options available for families outside major cities, while recognising that reliable internet access is not universal.

Education materials should avoid blame. A positive result may carry fear, shame or concerns about parenting, relationships and confidentiality. Supportive counselling can improve treatment adherence and help families make informed decisions about birth, feeding and newborn care.

Perinatal infection control is a shared responsibility across the health system. Researchers, clinicians and families benefit when evidence from different regions is brought together, especially for infections that affect communities unevenly. The archived FAOPS 2020 congress site preserves the context of a scientific meeting built around collaboration in perinatal and neonatal medicine.

Use current Australian clinical guidelines and local hospital protocols to shape every care plan, and involve an obstetric, neonatal or infectious disease specialist when transmission risk is known or suspected. Early assessment, respectful communication and reliable follow-up give parents and newborns the strongest protection across pregnancy, birth and the first months of life.