Early Onset neonatal Sepsis

Question 1

What is Early Onset Neonatal Sepsis?

Answer 1

• Sepsis occurring within the first 48-72 hours of life.

Question 2

What is the most frequent cause of neonatal infection?

Answer 2

• Group B Streptococcus
• E.coli
• H.Influenza

Question 3

What is the Pathophysiology of early onset neonatal sepsis?

Answer 3

• Caused by ascending infection in the mother with chorioamnionitis (a serious infection that affects a person during pregnancy)
• Perinatally via direct contact on the birth canal and haematogenous spread

Question 4

How does early onset neonatal sepsis typically first present?

Answer 4

• Respiratory Distress
• Pneumonia
• Septicaemia

Question 5

How does later (after 72hours) Neonatal Sepsis typically present?

Answer 5

• Septicaemia
• Meningitis

Question 6

How to prevent GBS infections in babies?

Answer 6

• In the UK, mothers that are found to be GBS positive around time of delivery will be given intrapartum antibiotics to prevent transmission to the baby
• If Chorioamnionitis is suspected then broad-spectrum antibiotics should be included in GBS cover

Question 7

What are the Risk Factors for Early Onset Neonatal Sepsis?

Answer 7

• Parenteral Antibiotic treatment given to the woman for confirmed/ suspected invasive bacterial infection at any time during labour
• Suspected or confirmed infection in another baby in the case of a multiple pregnancy
  Intrapartum fever higher than 38degrees
• Prelabour rupture of the membranes
• Preterm birth following spontaneous labour

Question 8

What are the Clinical features suggestive of infection?

Answer 8

• Respiratory distress more than 4 hours from birth
• Seizures
• Need for mechanical ventilation
• Signs of shock
• Feeding difficulties
• Jaundice within 24hours of birth

Question 9

What are the Red Flag signs suggestive of neonatal infection?

Answer 9

• Systemic antibiotics given to the mother within 24 hours of birth due to suspected bacterial infection
• Seizures
• Signs of shock
• Respiratory Distress more than 4 hours after birth
• Need for mechanical ventilation in a term baby
• Suspected/ confirmed infection in a co-twin

Question 10

What are the Differential Diagnosis for Early Onset Neonatal Sepsis?

Answer 10

• Transient Tachypnoea of the newborn (TTN) (causes tachypnoea and increased work of breathing)
• Surfactant deficient lung disease/ Respiratory Distress Syndrome (tachypnoea and increased work of breathing)
• Meconium Aspiration (respiratory distress and requires intubation, causes a raise in CRP)
• Haemolytic Disease of the Newborn
• Bacterial Meningitis
• UTI

Question 11

What are the Investigations for Early Onset Neonatal Sepsis?

Answer 11

-FBC, CRP, Blood Cultures
- Lumbar Puncture: to obtain Cerebrospinal fluid before starting antibiotics

Question 12

What is the management of Early Onset Neonatal Sepsis?

Answer 12

• IV benzylpenicillin with gentamicin
• Stop Abx if:
  1. Blood Culture is negative,
  2. Initial clinical suspicion of infection was not too strong,
  3. Baby’s condition is reassuring,
  4. Levels of CRP are reassuring
• Continue ABX:
  7-10days if Blood cultures are positive
  14 days if CSF is positive
  5days IV abx if negative blood cultures