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    Neonatal Sepsis: Prof DR Saima Batool

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    SAIMA BATOOL
    This document discusses neonatal sepsis, defining it as a systemic or local bacterial infection occurring in infants under 1 month of age. It describes the most common causative organisms as bacteria like E. coli, Group B Strep, and viruses such as enteroviruses and herpes simplex. Risk factors, clinical features, investigations, treatment involving empirical antibiotics, and prevention strategies are covered in detail. Complications can include endocarditis, abscesses and residual disability from septic joints if not properly treated.

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    Neonatal Sepsis: Prof DR Saima Batool

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    SAIMA BATOOL
    140 views31 pages
    This document discusses neonatal sepsis, defining it as a systemic or local bacterial infection occurring in infants under 1 month of age. It describes the most common causative organisms as bacteria like E. coli, Group B Strep, and viruses such as enteroviruses and herpes simplex. Risk factors, clinical features, investigations, treatment involving empirical antibiotics, and prevention strategies are covered in detail. Complications can include endocarditis, abscesses and residual disability from septic joints if not properly treated.

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    Neonatal sepsis

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    This document discusses neonatal sepsis, defining it as a systemic or local bacterial infection occurring in infants under 1 month of age. It describes the most common causative organisms as bacteria like E. coli, Group B Strep, and viruses such as enteroviruses and herpes simplex. Risk factors, clinical features, investigations, treatment involving empirical antibiotics, and prevention strategies are covered in detail. Complications can include endocarditis, abscesses and residual disability from septic joints if not properly treated.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    140 views31 pages

    Neonatal Sepsis: Prof DR Saima Batool

    Uploaded by

    SAIMA BATOOL
    This document discusses neonatal sepsis, defining it as a systemic or local bacterial infection occurring in infants under 1 month of age. It describes the most common causative organisms as bacteria like E. coli, Group B Strep, and viruses such as enteroviruses and herpes simplex. Risk factors, clinical features, investigations, treatment involving empirical antibiotics, and prevention strategies are covered in detail. Complications can include endocarditis, abscesses and residual disability from septic joints if not properly treated.

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    © All Rights Reserved
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    of 31

    NEONATAL SEPSIS

    Prof Dr Saima Batool


    NEONATAL SEPSIS
    LEARNING OBJECTIVES

     Define Neonatal sepsis


     Describe types of Neonatal infections.

     Describe Etiology of Neonatal infections.

     Describe risk factors of Neonatal infections.

     Describe clinical features of Neonatal infections.

     Interpret investigations of Neonatal infections

     Describe the steps of management of Neonatal


    infections.
    DEFINE NEONATAL SEPSIS
    INCIDENCE
    Males affected more than Females.
     1 in 500----Full term

     1 in 250-----Preterms
    RISK FACTORS FOR NEONATAL
    INFECTIONS
    ENVIRONMENTAL RISKS
     Mostly NICU based from 2001 survey.
     Total parenteral nutrition.

     Mechanical ventilation.

     Arterial line.

     Central venous line.

     Peripheral catheter.
    THE TIMING OF INFECTION DURING
    GESTATION
     First trimester infection:
    Congenital malformations (congenital rubella)
     Third-trimester infection:

    Active infection at the time of delivery


    (toxoplasmosis,syphilis)
     Infections that occur late in gestation:

    delayed clinical manifestations until after birth (syphilis).


    ETIOLOGY
    Systemic and local infections
    (lung,skin,ocular,umblical,kidney,bone&joint,meninges)
    Mode of transfer.
    Transplacental
    Transcervical
    Ascending infection of the fetus.
    COMMON ORGANISMS
     BACTERIAS:
     E.coli,

     Group B Streptococcus GBS

     H. influenza,

     Klebsiella,

     HSV1&2,

     Syphilis,

     listeria.
    VIRUSES

     Enteroviruses
     CMV

     Hepatitis A

     Adenoviruses

     Influenza virus

     RSV

     Rhinovirus

     Parainfluenza

     HSV

     Rotavirus.
    EARLY ONSET SEPSIS
    Birth-7 days.
    E.coli
    GBS,
    KLEBSIELLA,
    Listeria Monocytogenes,
    H.influenza.
    LATE ONSET SEPSIS( 4 DAYS TO 1
    MONTH OF AGE)
     Staphylococci
     Pseudomonas

     Adenovirus

     RSV

     E coli

     TB
    CLINICAL FEATURES
     Temperature instability: Only
    approximately 50% of infected newborn
    infants have a temperature higher than
    37.8°C (100°F) (axillary
     Hypotension, irritability, lethargy
    Poor perfusion with pallor
    and mottled skin
    CLINICAL FEATURES
    Tachycardia or bradycardia, apnea,
    respiratory
    distress, grunting, cyanosis,
    Seizures, feeding intolerance,
    abdominal distention, jaundice,
    petechiae, purpura, and bleeding.
    LABORATORY WORKUP
     CBC : band:neutrophil ratio of 0.2 or
    higher.Thrombocytosis or thrombocytopenia
     Blood C/S.

     CSFC/E and C/S.

     Urine C/E, C/S

     CRP

     BACTERIAL antigen in blood,urine,CSF.

     PCR, BACTEC

     CXR

     ABGs
     Tracheal aspirate for C/S
     Maternal IAP OR GBS
    yes

     Signs of sepsis yes full diagnostic work


    emperical therapy.
    NO

    Gestational age < 35 wk l limited evaluation


    , observe >48 hrs,if s/s full
    work up +ANTIBIOTICS.
     Gestational age >35w <2 doses same as
    above

    >2 doses of antibiotics before delivery

    No further evaluation or therapy needed.


    TREATMENT
    EMPERICAL Antibiotics :
    1.Ampicillin+gentamicin. 10-14 days.
    2.Ampicillin+cefotaxime.
    3. Vancomycin+aminoglycoside for Staphylococcal
    infection
    4. Carbapenem or imipenem. If suspecting meninigitits
    If meningitis---21 days of antibiotics or 14 days after CSF
    culture is –ve.
     Clindamycin or metronidazole: for anaerobic infections;

     Recombinant G-CSF

     Recombinant G-MSF

     IVIG
    ADJUNCTIVE THERAPIES
    Vitalsand Intake output monitoring.
    Fluids and electrolytes:
    Oxygenation:
    Shock and metabolic acidosis:
    Inotropic agents, sodium bicarbonate.
    Anemia: Blood transfusion
    ADJUNCTIVE THERAPIES
     Corticosteroids :for adrenal insufficiency and in cases of
    TB meningitis.
     If Hyperbilirubinemia: phototherapy and/or exchange
    transfusion.
     If Seizures: anticonvulsants.

     Parenteral nutrition.
    LATE ONSET SEPSIS
    Between 8-28 DAYS.
    S/S:
     Lethargy, Poor feeding, Hypotonia,
    Apathy,Seizures ,Bulging fontanelle, Fever,
    Direct hyperbilirubinemia.
     Meningitis.

     Osteomyelitis.

     Arthritis

     UTI.
    STEPS OF MANAGEMENT OF
    NEONATAL INFECTIONS
    TREATMENT
     Ampicillin+Cefotaxime and /or vancomycin.
     NOSOCOMIAL SEPSIS :

    TREATMENT:Ampicillin+Vancomycin( or
    oxacillin/nafcillin)+
    Aminoglycoside.
    COMPLICATIONS
     Endocarditis, Septic emboli, abscess formation, Septic
    joints with residual disability, and
     Osteomyelitis and bone destruction.

     Recurrent bacteremia: (<5%of patients)

     Candidemia: May lead to Vasculitis, Endocarditis.

     Endophthalmitis: As well as to abscesses in the


    kidneys, liver, lungs, and brain.
     Sequelae of sepsis: May result from septic shock, DIC,
    or organ failure
    PROGNOSIS
     Case fatality rate for neonatal bacterial meningitis is
    between 20% and 25%.
     Late complications of meningitis occur in 40-50%

    of survivors.
    PREVENTION
    MATERNAL STRATEGIES:
     Maternal immunization (rubella,hepatitis B, VZV).

     Toxoplasmosis; appropriate diet and avoidance of


    exposure to aged cat feces.
     Malaria: mosquito repellent nets, sprays etc

     Maternal Chorioamnionitis with antibiotic therapy


    during labor.

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