April 2 Lecture Flashcards
a severe infection in
newly born infants
Neonatal Sepsis
SIRS
systemic
inflammatory response syndrome
Definition of neonatal sepsis
Clinical syndrome of
bacteremia with systemic signs &
symptoms of infection in the first
four weeks of life.
SIRS can be identified by the presence of which 2 or more
of the following signs
✔ Abnormal heart rate
✔ Respiratory distress
✔ Abnormal leukocyte count
✔ Abnormal temperature
Two types of neonatal sepsis
○ Early Onset
○ Late Onset
Neonatal sepsis affects how much in every birth?
approximately 2 infants per
1,000 births
Neonatal sepsis has a higher incidence in?
in premature & low birth weight infants
Cause of neonatal sepsis
○ Bacteria
○ Immature immune response
○ Genetic predisposition
An important cell in immunity against pathogens
Neutrophils
Why does neonate’s neutrophils have decreased chemotaxis?
Due to decreased chemoattractant.
a type of WBC that ingests pathogens
Monocytes
Opsonization
The coating of a pathogen with
antibodies that makes it susceptible to phagocytosis
The process of cells (phagocytes) engulfing, ingesting, & destroying pathogens.
Phagocytosis
antibodies that promote opsonization
Opsonins
Pathogen’s route in entering a neonate’s body
✔ Prenatal period
✔ Perinatal period
✔ Postnatal period
Classifications of neonatal sepsis
● Congenital Infection
● Early-Onset Sepsis
● Late-Onset Sepsis
Major risk factor is maternal infection
Congenital Infection
When does early onset sepsis occur?
Birth to 7 days
When does late onset sepsis occur?
8 to 28 days
Where does late-onset sepsis acquired?
Acquired in hospital, home, or community.
5 associated factors for early-onset sepsis
✔ Prolonged rupture of membranes > 12 hours
✔ Difficult or prolonged labor
✔ Birth asphyxia and difficult resuscitation
✔ Multiple per vaginal examination
✔ Very low birth weight or preterm baby
A type of sepsis caused by the organisms of the external environment of home or hospital and is often transmitted through the hands of the care provider.
Late onset sepsis
Gram negative organisms in late onset sepsis
e. Coli
klebsiella
enterobacter
serratia
pseudomona
proteus
citrobacter
Presentation of late onset sepsis
septicemia
pneumonia
meningitis
5 organisms identified in late onset sepsis
○ Escherichia coli
○ Group B Streptococci
○ Streptococcus pneumoniae
○ Acinobacter species
○ Candida
Symptoms of neonatal sepsis
✔ Tachypnea
✔ Feeding difficulties
✔ Difficulty breathing
✔ Irritability
✔ Heart rate changes
✔ Temperature instability
✔ Jaundice
Most common manifestations in neonatal sepsis
- Respiratory distress
- Altered feeding behavior
- Baby who was active, suddenly or gradually becomes lethargic, inactive or unresponsive & refuses to suckle.
- Temperature instability
- Skin
- Metabolic
Diagnostic tests in neonatal sepsis
A. Non-specific - WBC count & differential, Platelet count,
B. Definitive specific Cultures - Blood, CSF
C. Radiology - Chest X-Ray, Renal ultrasound, CT scan
Treatment for neonatal sepsis
antibiotics & supportive therapy
Antibiotics for neonatal sepsis
ampicillin & aminoglycoside
When is gentamicin effective?
within 10-14 days effective against most organisms responsible for early-onset sepsis.
An alternative method of
antibiotic treatment for late onset sepsis
combination of ampicillin and cefotaxime
Prevention for late onset sepsis
● Good prenatal care
● Materna infections diagnosed & treated early
● Babies should be breastfeed early
● Infection control policies applied
in the unit
Nursing diagnosis for late onset sepsis
- Fluid Volume Deficit
- Ineffective Tissue Perfusion r/t impaired transport of oxygen across alveolar & on capillary membrane
3 Nursing interventions for FVD
- Monitor & record v/s
- Provide oral care by moistening lips & providing daily bath
- Provide TSB if patient has fever
3 Nursing interventions for Ineffective Tissue Perfusion
- Note quality & strength of peripheral pulses
- Assess skin for changes in color, temp, & moisture
- Assess RR, depth, and quality
An acute inflammation of the meninges & CSF
Bacterial Meningitis
It remains a significant cause of illness in the pediatric age groups because of undiagnosed & untreated or inadequately treated cases
Bacterial Meningitis
Causes of Bacterial Meningitis
bacterial agents
○ H. influenza type B
○ S. pneumoniae & Neisseria meningitidis
○ B. hemolytic streptococci
○ E. Coli
5 routes organisms in bacterial meningitis also gain entry by:
○ Direct implantation after penetrating wounds
○ Skull fractures
○ Lumbar puncture
○ Surgical procedures
○ Anatomic abnormalities (Spina Bifida)
5 clinical manifestations of bacterial meningitis
✔ Fever, chills, headache, & vomiting
✔ Alteration in sensorium
✔ Seizure
✔ Irritable, agitated
✔ Confusion, hallucination
Diagnostic evaluation in bacterial meningitis
● Lumbar puncture
● Culture & sensitivity test of CSF
● CT Scan of the head
● CBC (increased WBC)
Therapeutic management in bacterial meningitis
● Inititation of antimicrobial therapy
● Maintenance of hydration
● Maintenance of ventilation
● Management of systemic shock
● Control of temperature
when one or more parts of the urinary system (kidneys, ureters, bladder, or urethra) become infected with a pathogen
Urinary Tract Infection
Most frequent pathogen in UTI
bacteria
3 Basic Forms of UTI
- Pyelonephritis
- Cystitis
- Asymptomatic Bacteriuria
The most common serious bacterial
infection in infants.
Pyelonephritis
A bacterial infection of the kidneys
Pyelonephritis
Cause of an acute or chronic pyelonephritis
Often due to ascending of bacteria from bladder up to ureters.
Clinical pyelonephritis is characterized by:
● Abdominal, back, or flank pain
● Fever (may be the only manifestation)
● Malaise
● Nausea
● Vomiting
● Diarrhea (occasionally)
What do you call the extreme overextension of the child’s neck?
opisthotonos
Newborns can show nonspecific symptoms in pyelonephritis such as:
● Poor feeding
● Irritability
● Jaundice
● Weight loss
It indicates that there is bladder involvement
Cystitis
Symptoms of cystitis
○ Dysuria
○ Urgency
○ Frequency
○ Suprapubic pain
○ Incontinence
○ Malodorous urine
Route of bacteria in UTI
bacteria arise from the fecal flora, colonize the
perineum, & enter the bladder via the urethra
In uncircumcised boys, where does the bacterial pathogens arise?
It arise from the flora beneath the prepuce.
In some cases, where does the bacteria causing cystitis ascend to?
It ascends to the kidney to cause pyelonephritis.