9.1 A Neonatal Sepsis Flashcards
Explain why neonates are susceptible to infection
- Prematurity
- maternal neonatal & envionmental factors
- immature immune system
- the response from neutrtophils macropahges and lymphocytes can be inadedquate
- Limited immunoglobulins to effectivey combat pathogens
Explain sources of infection in a newborn
- susceptilbe host comes into contact with potentially pathogenic orgniasm
- maybe early onset - (within 48) (before birth)
- may manifest with pneumonia and or septicaemia
- Prolonged ruture membranes 18 hours or longer
- fetal distress
- Chorioamnionitis
- Maternal pyrexia or overt infection
- multiple obstetric invasive procedures
- UTI
- CMV
- herpes
- Syphilis
- chickenpox
- AIDS
- Parvo
- pre term
- hx of GBS infection with previous baby
- GBS bacteriura this pregnancy
-
late onset (is often more severe)
* after 48/24
hospital enviroment
coagulase negative staphylococcus
staphylococcus aureus (peak incidence day 10-22) - foreign bodies such as IVC or endotracheal tubes
- healthcare worker
- parents
- antenatal
- intrapartum
- post birth
- GBS
Identify common pathogens to which neonates are most susceptible
- gbs
- ecoli
- gram negative bacteria
- UTI
Discuss how infection can be prevented in the fetus and neonate
fetus
* antibotics to the mother during labour
* antis if prolonged PROM
* GBS swab
Neonate
* hand hygiene
* not allowing anyone into the NICU or SCN that has any symptoms present
*
Understand the signs and symptoms of infection in the neonate
- Pall
- Lethargy
- Jaundice
- Fever
- Hypothermia
- temperature instability
- Poor tolerance to handling
- Hypo or hyper glycaemia
- blood gas derangement including acidosis and lactat accumulation
- Cardiovascular system symptoms
Understand the signs and symptoms of infection in the neonate - Respiratory signs
Respiratory symptoms
* ^RR
* apnoea
* grunting
* cyanosis
* increased O2 requirement
Understand the signs and symptoms of infection in the neonate - Cardiovascular
- Tachycardia
- bradycardic episodes
- poor perfusion - cyanosis
- hypotension
*
Understand the signs and symptoms of infection in the neonate - Cutaneous Symptoms
- petechiae
- bruising
- mottleing of skin
- rash/pustules
- clammy skin
- umbi stump (redness/sloughiness/ moist/odour)
- bleeding from puncture sites
- dusky
Understand the signs and symptoms of infection in the neonate -CNS
- Lethargy
- irritability
- seizures
- altered conscious state
- jitteriness/tremors
- low tone
- decreased flexes
- hyotonia/hypertonia
- buldging fontanelle
- poor feeding
Understand the signs and symptoms of infection in the neonate - haemodynamic
- Cap refill time > 2-3 secs
- pallor
- cyanosis
- htn
- crp
- abnormal full blood count
- abnormal clotting factors
- acidosis
- ph
- metabolic acidosis
Understand the signs and symptoms of infection in the neonate - thermoregulation
- Febrile
- Cold
- temperature instability
- cool periheries
Understand the signs and symptoms of infection in the neonate - GIT
- Poor feeding
- Vomiting
- Abdo distension
- Feed intolerance
- bilious aspirates/vomits
- loose stools
- hypo or hyper glycemia
- blood in stools
- spleenomegaly (enlarged spleen)
Describe the treatment and management of infection in the neonate
- FBE
- CRP
- Blood gases
- +/-Blood cultures if + LP must be performed
- Serum
- true blood sugar
- CXR
- +/- lumbar puncture
LOS = supra pubic urine aspirate
commence antibotics dont delay
Holistic care based on best available evidence
Describe midwifery interventions that can mitigate risk factors for neonatal sepsis.
- Intrapartum
- give antibotics when due
- closely monitor maternal temp
* - neonate
- A/C obs
- breast feed as soon as possible
- monitor for any signs of spesis
Identify, assess, plan, implement and evaluate the care of the newborn with sepsis
- Thermal care
- isolete
- Phototherapy if required
- monitoring o2, HR, BP
Respiratory - Support for apnoea
- Hypoxia
- hypercapnoea
- RDS
Cardio - IVT 10-20ml per kg
- inotrope support is often needed and transfer to level 5-6 neonatal unity
- correction of fluids, electrolytes, g;ucose and haematological derangement
- enteral feeding is often required ( using EBM if available)
Antibiotic - ben pen - 60mg/kg/dose IV BD
- Gent 5mg/kg/ dose 36 hourly if >1200 grams 48/24 if under 1200
- FBC -strict
- nesting
- BF if possible via NGT
