Professional Documents
Culture Documents
Prematurity
Pneumonia 18%
NCD 9%
Diarrhea 7%
Injury 4%
Meningitis 3%
Pertussis 1%
Malaria 1%
HIV 0%
Measles 0%
Other infections 12%
Time of Onset
Maternal
Obstetric
Complications
Transmission
/ Organism
Source
Clinical
Manifestation
Early Onset
Late Onset
Very Late
Onset
(Nosocomial)
>30 days
Birth to 7
days, usually
<72 hrs
Often present
7 days to 30
days
Usually
absent
Varies
Vertical:
Maternal
genital tract
Fulminant
course,
multisystem
involvement;
Pneumonia
common
Vertical
or
postnatal
environment
Insidious,
focal
infection;
Meningitis
common
Environment
/ community
Multisystem
or focal
Maternal fever
Chorioamnionitis
Maternal UTI
Functional deficiencies of
neonatal host defense
mechanisms
Late Onset
Prematurity
Prolonged hospitalization
Invasive
procedures:
umbilical
catheters,
endotracheal intubation
Parenteral alimentation
Prior use of antibiotics
Medications (H2-blockers)
(alter GI environment pH)
Functional deficiencies of
neonatal host defense
mechanisms
and
Chorioamnionitis
Elevated maternal temperature
Uterine tenderness
Maternal leukocytosis
Fetal tachycardia
Foul-smelling amniotic fluid
(Send placenta for histopathologic examination.)
Transmission of Infection
1. Transplacental
CMV and Rubella
Listeria monocytogenes
Treponema pallidum (syphilis)
2. Vertical
Ascending route: following rupture of membranes
Passage through the birth canal by colonization
3. Postnatal
Direct contact with caregiver
Environmental / contaminated equipment
Group B streptococcus
(most common in developed
countries)
Listeria monocytogenes
Haemophilus influenzae
Late Onset
Coagulase negative
Staphylococcus
epidermidis (nosocomial
pathogen)
Staphylococcus aureus
Gram negative enteric
bacilli
Pseudomonas aeruginosa
Enterococcus spp.
Fungal (most common:
Candida albicans in babies
with prolonged stay in NICU)
Enterobacter aeruginosa
Klebsiella pneumoniae
Staphylococcus aureus
Temperature instability
Hypothermia and, rarely, hyperthermia
Feeding intolerance
Vomiting, abdominal distension, poor feeding
pattern
Abnormal heart rate and blood pressure
Tachycardia, bradycardia, hypotension (to measure
BP, use the flush method; normal: >50 mmHg)
Metabolic problems
Hypoglycemia, hyperglycemia, metabolic acidosis
Abnormal neurologic status
Lethargy, hypotonia, seizures
o ANC 1,500
o Platelets <100,000
Blood is usually tested after 6-8 hours of life to remove the effect of
stress.
CRP:
- Not useful in the first 48 hrs d/t presence of inflammatory
changes leading to false (+) results
- (+) result: agglutination of latex beads using undiluted serum
- More useful for monitoring
Final Diagnosis:
- Sepsis in the newborn, unspecified if culture (-)
- Sepsis in the newborn, E. coli if culture (+)
Treatment of Sepsis
In any infant suspected of sepsis, antimicrobial therapy
should be initiated immediately after completion of
diagnostic evaluation.
The progression of the disease may be too rapid to await
confirmation from blood or other cultures.
The decision to initiate treatment for sepsis is based
upon clinical history, signs and symptoms, and laboratory
results.
A normal CBC or a negative culture does not rule out the
presence of sepsis.
EARLY ONSET: In the initial treatment of neonatal sepsis,
it is best to begin antimicrobial therapy with
ampicillin or penicillin in combination with an
aminoglycoside. (always with 2 drugs and given IV!)
LATE ONSET: The principles of management of late-onset
sepsis (nosocomial) are identical to those for the
treatment of early onset sepsis. It is best to initiate
therapy with broad spectrum coverage that will be
effective for most nosocomial pathogens.
Duration:
o The duration of parenteral antibiotic therapy should be
10-14 days.
Gram (+) : 10 days
Gram (-) : 14
o In the presence of meningitis, antibiotic treatment
should be given for 14-21 days.
Gram (+) : 14 days
Gram (-) : 21 days
Adjunctive Therapies:
o Intravenous immunoglobulin
o Granulocyte transfusion
o Exchange transfusion (to remove toxins in the circulation)
Supportive Therapy:
o Respiratory adequate oxygenation (mechanical
ventilator if needed)
Complications of Sepsis
Bacterial meningitis (sometimes already present upon
presentation)
Septic shock
Multiple organ failure
Prevention
What measures may be undertaken to prevent severe
sepsis?
The presence of maternal risk factors for newborn
sepsis warrant immediate diagnosis and treatment of the
infant following delivery.
To prevent nosocomial infections, the following
measures should be implemented:
o Meticulous handwashing by caregivers
o Proper staffing ratio and adequate space in between
babies
o Rational use of antimicrobials (meropenem and
Nosocomial sepsis
- Acquired in the hospital: delivery room, nursery, neonatal ICU
- Late or very late onset (more common in babies who stay
longer at the hospital)
- Relatively uncommon in the normal term infants but higher
incidence among low birth weight infants)
Deficient cellular and humoral immune response
- IgG transplacentally transferred; therefore, IgG levels of
infant is dependent on the mother
- WBC neutrophils lack capability to phagocytose bacteria