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TAS Neonatal Medicine ✅ > Early-Onset Infection ✅ > Flashcards

Early-Onset Infection ✅ Flashcards

1
Q

What can infection in the newborn be divided on the basis on?

A

Time during pregnancy/postnatal when the infection is acquired or presents

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2
Q

What are the categories of neonatal infection?

A
  • Congenital
  • Early onset
  • Late onset
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3
Q

What is considered to be early onset infection in neonates?

A

<72 hours after birth

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4
Q

Why are newborn infants particularly vulnerable to bacterial infection?

A

Because of their immature immune system

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5
Q

How does the immune system of a neonate compare to older infants?

A

They are more dependant on non-specific innate immune system than older infants, because adaptive immune system is both immunologically naive and relatively slow to function, with overall reduced T-cell, B-cell, and neutrophil function

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6
Q

What kind of pathogens are neonates particularly susceptible to?

A

Pathogens with polysaccharide capsules

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7
Q

Give 2 examples of pathogens with polysaccharide capsules?

A
  • Group B strep

- E. Coli

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8
Q

Why are neonates particularly susceptible to pathogens with polysaccharide capsules?

A

Because they have relatively low complement and impaired opsonisation

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9
Q

How does the complement pathway of a neonate compare to older children?

A

Overall activity of the alternative complement pathway is diminished, and the classical complement pathway activation cannot take place due to lack of specific antibodies

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10
Q

Where do the pathogens come from in early-onset infection?

A

The infant is exposed to bacterial organisms from maternal ascending infection or during passage through the birth canal

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11
Q

What is the most common organism causing early onset infection?

A

GBS

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12
Q

What other organisms might cause early onset infection?

A
  • Gram -ve organisms
  • Listeria monocytogenes
  • Staphylococcus
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13
Q

What are the maternal risk factors for early-onset infection?

A
  • GBS colonisation or bacteriuria during pregnancy
  • Prolonged rupture of membranes
  • Preterm prolonged rupture of membranes
  • Prolonged labour
  • Maternal sepsis or chorioamnionitis
  • Frequent pelvic examinations
  • History of early onset GBS sepsis in a previous infant
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14
Q

What is considered to be prolonged rupture of membranes?

A

> 18-24 hours

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15
Q

What is considered to be preterm prolonged rupture of membranes?

A

<37 weeks of gestation

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16
Q

What is considered to be prolonged labour?

A

> 12 hours

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17
Q

What are the clinical features of chorioamnionitis?

A
  • Temperature >38
  • Leucocytosis
  • Tender uterus
  • Purulent liquor
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18
Q

What is the fatality rate of GBS sepsis in term infants?

A

6%

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19
Q

What is the fatality rate of GBS sepsis in preterm infants?

A

Up to 20%

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20
Q

What is the rate of GBS colonisation in pregnant women in the UK?

A

21%

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21
Q

In what % of women with GBS colonisation does early-onset infection occur?

A

Less than 1%

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22
Q

What is the overall incidence of early onset GBS infection?

A

0.5/1000 live births

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23
Q

Where is universal screening of pregnant women for GBS performed?

A

USA, Canada, and Australia

24
Q

What is done with women who test positive for GBS in pregnancy in countries that universally screen?

A

Intrapartum antibiotic prophylaxis is given to colonised mothers between 35 and 37 weeks gestation, or before this if in labour

25
Q

What effect has universal screening for GBS had on the US?

A

It has lead to a significant reduction in culture positive early-onset disease and sepsis related mortality in the first week. Late onset disease has been unaffected.

26
Q

What % of UK maternal units practice universal GBS screening?

A

Less than 1%

27
Q

What approach to GBS in pregnancy has been adopted in the UK?

A

A risk factor based approach

28
Q

What is the risk factor based approach to GBS in pregnancy in the UK?

A

Intrapartum antibiotic prophylaxis if certain criteria are met

29
Q

When will intrapartum antibiotic prophylaxis against GBS be given?

A
  • History of invasive GBS infection in previous baby
  • GBS bacteriuria or positive vaginal swab in current pregnancy
  • Pyrexia (<38) in labour, or chorioamnionitis
30
Q

When is intrapartum antibiotic prophylaxis not required for GBS, even when the criteria are met?

A

If delivery by pre-labour lower segment C-section with intact membranes

31
Q

What are the risk factors for early-onset GBS sepsis?

A
  • Intrapartum fever over 38
  • Prolonged rupture of membranes (>18 hours) at term
  • Prematurity
  • Positive GBS swab in previous or current pregnancy
32
Q

Is the presence of a single risk factor an indicator for starting antibiotics/doing a septic screen in GBS?

A

No

33
Q

By how much does the presence of 1 risk factor increase the risk of GBS sepsis?

A

1%

34
Q

By how much does the presence of 2 risk factors increase the risk of GBS sepsis?

A

5%

35
Q

By how much does having 3 risk factors increase the risk of GBS sepsis?

A

25x the baseline

36
Q

What is considered a major risk factor for early-onset GBS sepsis?

A
  • Matnal sepsis
  • Chorioamnionitis
  • GBS bacteruria
  • Invasive GBS infection in previous infant
37
Q

What % of infants with early onset GBS sepsis present on day 1?

A

94%

38
Q

What proportion of infants presenting with GBS sepsis have one or more risk factor before or during labour?

A

2/3

39
Q

What warning signs are found in a significant proportion of neonates presenting with early-onset sepsi?

A
  • Signs of fetal distress
  • Emergency delivery
  • Low Apgar scores
40
Q

What % of infants with early-onset GBS infection present with sepsis?

A

79%

41
Q

What % of infants with early-onset GBS infection present with meningitis?

A

12%

42
Q

What % of infants with early onset GBS infection present with pneumonia?

A

8%

43
Q

What % of infants with early onset GBS infection present with focal infection?

A

1%

44
Q

How is a diagnosis of GBS sepsis confirmed?

A

Blood culture

45
Q

How much blood is required for blood culture?

A

At least 1ml

46
Q

Why is it recommended that at least 1ml is taken for blood culture?

A

Smaller blood volumes reduces test sensitivity

47
Q

Why should an LP be considered in early-onset GBS infection?

A

Up to 23% of neonates with bacteraemia have meningitis, and a negative blood culture does not rule out meningitis

48
Q

When should an LP be done in early-onset GBS infection?

A
  • Clinical deterioration on antibiotic treatment

- Positive blood culture

49
Q

Why is it important to make a diagnosis of meningitis in early-onset GBS infection?

A

A prolonged course of antibiotics is indicated

50
Q

Why is CRP not that helpful in early-onset GBS sepsis/

A

A raised CRP depends on an inflammatory response with the release of IL-6, so is rarely helpful in initial evaluation of possible infection

51
Q

What is the importance of a raised CRP in early-onset sepsis?

A

In early-onset sepsis, a single raised CRP 24 hours into illness has a 93% sensitivity for ‘probably sepsis\

52
Q

When can CRP be particularly helpful as a negative test?

A

After 18-24 hours - 99% predictive of non-infected infant

53
Q

What are the NICE guidelines for stopping antibiotics in early onset GBS infection?

A

Consider stopping at 36 hours if;

  • CRP concentration and trend is reassuring
  • Blood culture negative
  • Risk factors for infection were not strong
  • Baby has no clinical indicators for infection
54
Q

Should routine superficial swabs or gastric aspirated be taken in early onset GBS sepsis?

A

No - no added value

55
Q

What does the management of early onset GBS sepsis rely on?

A

Early recognition from high levels of clinical suspicion, and prompt initiation of antibiotics and supportive treatment

56
Q

Is the use of intravenous immunoglobulin as an adjunctive therapy helpful in early-onset GBS infection?

A

No

TAS Neonatal Medicine ✅ (35 decks)

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