Demystifying the TORCH screen: an approach to the newborn suspected of congenital infection

<h2>Abstract</h2> Congenital infections are a significant cause of neonatal morbidity and mortality, often presenting with a diverse range of clinical features that pose diagnostic and management challenges. This review breaks down the TORCH screen, often referred to in neonatal and paediatric medicine as a generic congenital infection screen. We provide a comprehensive overview of the clinical approach to a neonate suspected of congenital infection, encompassing initial evaluation, diagnostic strategies, and therapeutic interventions. It outlines key clinical manifestations, such as intrauterine growth restriction, hepatosplenomegaly, rash, and neurologic signs, that may prompt investigation for congenital pathogens including cytomegalovirus, toxoplasmosis, syphilis, rubella, herpes simplex virus, and others. Diagnostic workup is guided by maternal history, antenatal screening, and targeted investigations, including laboratory testing, imaging, and specialist input. Management involves pathogen-specific therapy, supportive neonatal care, and addressing complications such as hearing loss or neurodevelopmental delay. The article emphasizes the importance of close monitoring and multidisciplinary follow-up to identify and manage long-term sequelae. In addition, it reviews strategies for prevention, including antenatal screening, maternal vaccination, and infection control practices. Finally, it discusses the broader public health implications, such as surveillance programs and the role of early diagnosis in mitigating the burden of disease. A structured, evidence-based clinical approach is essential to optimize outcomes for affected neonates and reduce the incidence of preventable congenital infections.