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    Neonatal Sepsis

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    Kimbek Buangke
    This document discusses neonatal sepsis, including causes, risk factors, clinical presentation, diagnosis, treatment, and prevention. The direct causes of neonatal death are infections (32%), asphyxia (29%), prematurity complications (24%), congenital anomalies (10%), and other (5%). Neonatal sepsis is defined as systemic illness with bacteremia in the first month of life. It can be early-onset from vertical transmission, late-onset from horizontal transmission, or nosocomial from invasive procedures. Common symptoms include temperature irregularity, feeding problems, and respiratory/cardiovascular issues. Diagnosis involves cultures, labs like complete blood count and CRP, and imaging tests. Treatment is with antibiotics and supportive care like

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    Neonatal Sepsis

    Uploaded by

    Kimbek Buangke
    580 views26 pages
    This document discusses neonatal sepsis, including causes, risk factors, clinical presentation, diagnosis, treatment, and prevention. The direct causes of neonatal death are infections (32%), asphyxia (29%), prematurity complications (24%), congenital anomalies (10%), and other (5%). Neonatal sepsis is defined as systemic illness with bacteremia in the first month of life. It can be early-onset from vertical transmission, late-onset from horizontal transmission, or nosocomial from invasive procedures. Common symptoms include temperature irregularity, feeding problems, and respiratory/cardiovascular issues. Diagnosis involves cultures, labs like complete blood count and CRP, and imaging tests. Treatment is with antibiotics and supportive care like

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    This document discusses neonatal sepsis, including causes, risk factors, clinical presentation, diagnosis, treatment, and prevention. The direct causes of neonatal death are infections (32%), asphyxia (29%), prematurity complications (24%), congenital anomalies (10%), and other (5%). Neonatal sepsis is defined as systemic illness with bacteremia in the first month of life. It can be early-onset from vertical transmission, late-onset from horizontal transmission, or nosocomial from invasive procedures. Common symptoms include temperature irregularity, feeding problems, and respiratory/cardiovascular issues. Diagnosis involves cultures, labs like complete blood count and CRP, and imaging tests. Treatment is with antibiotics and supportive care like

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    580 views26 pages

    Neonatal Sepsis

    Uploaded by

    Kimbek Buangke
    This document discusses neonatal sepsis, including causes, risk factors, clinical presentation, diagnosis, treatment, and prevention. The direct causes of neonatal death are infections (32%), asphyxia (29%), prematurity complications (24%), congenital anomalies (10%), and other (5%). Neonatal sepsis is defined as systemic illness with bacteremia in the first month of life. It can be early-onset from vertical transmission, late-onset from horizontal transmission, or nosocomial from invasive procedures. Common symptoms include temperature irregularity, feeding problems, and respiratory/cardiovascular issues. Diagnosis involves cultures, labs like complete blood count and CRP, and imaging tests. Treatment is with antibiotics and supportive care like

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
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    The main direct causes of neonatal deaths according to WHO are infections, asphyxia, complications of prematurity, congenital anomalies, and other causes. Neonatal sepsis can be classified into early-onset disease, late-onset disease, and nosocomial sepsis based on the time of onset. Some risk factors for neonatal sepsis include prematurity, rupture of membranes over 18 hours, maternal fever or infection, and invasive procedures.

    According to the text, the direct causes of neonatal deaths reported by the World Health Organization in 2001 are: infections (32%), asphyxia (29%), complications of prematurity (24%), congenital anomalies (10%), and other causes (5%).

    The text describes three types of neonatal sepsis based on onset: early-onset disease which presents in the first 5-7 days of life and is acquired during birth from the maternal genital tract, late-onset disease which has an onset in the first week of life and is transmitted horizontally, and nosocomial sepsis which occurs in high-risk newborns in the NICU.

    NEONATOLOGY DIVISION

    Department of Child Health Medical School


    University of Sumatera Utara

    Direct Causes of Neonatal Deaths


    World Health Organization. State of the Worlds Newborns 2001

    Infections 32%
    Asphyxia 29%
    Complications of prematurity 24%
    Congenital anomalies 10%
    Other 5%

    NEONATAL SEPSIS
    DEFENITION
    Neonatal sepsis is a clinical
    syndrome
    Of sistemic illness accompanied by
    bacteremia occuring in the first month
    of life

    PATHOPHYSIOLOGY
    1.

    Early-onset disease
    Present in the first 5-7 days of life
    Acquired the organism during the
    intrapartum period from the maternal
    genital tract.
    Usually vertical transmission from
    mother
    Treponemes, viruses, Listeria, Candida

    PATHOPHYSIOLOGY
    2. Late-onset disease
    Onset first week of life
    History of obsteric complications
    Horizontal transmission
    Predilection for central nervous
    system

    Pathogens in Late Onset Sepsis


    in VLBW Neonates
    NICHD Neonatal Research Network Experience (Pediatrics 2002)

    Organism
    Gram positive organisms
    Staphylococcus- coagulase negative
    Staphylococcus aureus
    Group B Streptococcus

    %
    70.2
    47.9
    7.8
    2.3

    Gram negative organisms


    E.coli
    Klebsiella
    Pseudomonas
    Enterobacter

    17.6
    4.9
    4.0
    2.7
    2.5

    Fungi
    Candida albicans
    Candida parapsilosis

    12.2
    5.8
    4.1

    PATHOPHYSIOLOGY
    3. Nosocomial sepsis
    Occurs in high-risk newborn infant
    Invasive monitoring used in NICU
    Breaks in the natural barrier function of
    the skin and intestine
    4. Causative organism
    Most common group B strptococci (GBS)

    RISK FACTOR
    1.
    2.
    3.
    4.

    5.

    Prematurity and low birth weight


    Rupture of membranes: > 18 h
    Maternal peripartum fever (>380C) or
    infection.
    Amniotic fluid problems: meconiumstained or foul smelling, cloudy amniotic
    fluid
    Resuscitation at birth

    RISK FACTOR
    6. Multiple gestation
    7. Invasive procedures
    8. Infant with galactosemia
    9. Iron therapy: enhances the growth of
    many organism

    CLINICAL PRESENTATION
    Temperature irregularity: hypo or
    hyperthermia
    2. Change in behavior: lethargy, irritability,
    or change in tone.
    3. Skin: poor peripheral perfusion,
    cyanosis, mottling, pallor, petechiae,
    rashes, sclerema, or jaundice.
    1.

    Pseudomonas sepsis with DIC

    Invasive Candidiasis

    CLINICAL PRESENTATION
    4. Feeding problem: feeding intolerance,
    vomiting, diarrhea, abdominal distention.
    5. Cardiopulmonary: tachypnea,
    respiratory distress, apnea, tachycardia,
    hypotention.
    6. Metabolic: hypo or hyperglycemia or
    metabolic acidosis.

    DIAGNOSIS
    1.

    Laboratory studies
    Cultures: blood and body fluids
    Grams stain of various fluids
    Adjunctive laboratory tests: WBC count with
    differential, platelet count, acute phase
    reactant (CRP, IL-1, IL-6, IL-8, and TNF),
    surface neutrophil CD11.
    Miscellaneous tests: bilirubin, glucose,
    sodium

    Lumbar Puncture

    Possibility

    of meningitis 1-10%
    Not all infants with meningitis
    will have specific symptoms
    15%

    of babies with meningitis will


    have negative blood culture

    Abnormal white blood cell count


    Total

    WBC count < 5000 /L, > 25.000/L


    Total neutrophil count: <1000/L
    Immature to total neutrophil ratio > 0.2
    Immature to mature neutrophil ratio > 0.2
    bandform
    neutrophil

    C- Reactive Protein
    Acute

    phase reactant: synthesized in 6 to hours


    Normal: < 1.6 mg/ dl on day 1, then < 1.0 mg/ dl
    Falsely elevated with asphyxia, meconium
    aspiration, PROM
    May not be positive early (only 60% sensitivity)
    Repeated tests more useful (up to 84%
    sensitivity)
    Negative Predictive value: 90%

    DIAGNOSIS
    2. Radiologic studies
    Chest x-ray
    Urinary tract imaging
    3. Other studies: examination of the
    placenta

    Chest X Ray

    Group

    B streptococcal sepsis:
    diffuse ground glass opacity
    indistinguishable from HMD
    Persistent focal parenchymal lung
    findings

    Group B Strep
    Pneumonia

    Treatment of Neonatal Sepsis


    Specific
    Antibiotics: Ampicillin +
    Aminoglycoside (gentamicin)
    In nosocomial sepsis, staphylococcal
    coverage with Vancomycin +
    aminoglycoside or 3th generation of
    cephalosporin.

    Treatment of Neonatal Sepsis


    Supportive care
    Temperature
    Cardiorespiratory
    Hematological
    - DIC: FFP, Vit K, exchange transfusion
    - Neutropenia: recombinant human
    granulocyte colony-stimulating factor (rhG
    CSF) or recombinant human granulocyte
    macrofag colony-stimulating factor

    CNS: seizure controle


    Metabolic: monitor and treat hypo or
    hyperglycemia and metabolic acidosis.

    Reduction of Nosocomial Infection


    Handwashing
    Early

    feeding
    Maternal breast milk
    Intravenous immunoglobulin
    Decrease use of broad spectrum
    antibiotics
    Decrease use of H2 receptor blockers

    Prevention of Sepsis

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