Infection

Question 1

Why are neonates more susceptible to infection?

Answer 1

• Immature immune system
• Exposure to microorganisms from genital tract of mother
• Exposure to infections in utero
• Trauma to baby skin e.g. cuts

Question 2

Common bacterial infections in neonates?

Answer 2

• Chlamydia
• Gonorrhoea
• Group B strep
• Staphylococcus aureus

Question 3

Common fungal infections in neonates?

Answer 3

• Neonatal candidiasis

Question 4

Common neonatal viral infections in neonates?

Answer 4

• Cytomegalovirus
• Herpes
• Hepatitis B
• Hepatitis C

Question 5

Signs and symptoms of infection?

Answer 5

• Temperature instability/Pyrexia
• Tachyapnoea
• Tachycardia
• Nasal flaring
• Poor feeding
• Lethargic
• Intercostal recession
• Grunting
• Green stool
• Vomiting
• Abdominal distension
• Poor peripheral circulation
• Petechial rash

Question 6

What midwifery actions will you take if infection is suspected?

Answer 6

• Full set of obs (Temp, RR, HR, Colour, Tone, Femoral Pulses, Behaviour, Feeding) - 1, 4 hours post birth then 4hrly
• O2 sats = 1 and 4 hours post birth
• BGL if indictated
• Full check
• Weigh
• Assess feed (frequency, length, waking for feeds, behaviour at feeds, swallows heard?)
• Birth/antenatal history - e.g. group B strep, PROM
• Feeding history (length, effectiveness, output, blood glucose)
• Output = frequency, colour, texture
• Family’s thoughts
• Include and discuss with family, plans and reasoning, informed consent, opportunity for questions, check understanding, partnerships, cultural safety
• Document findings
• Consult/refer/handover

Question 7

What is group B strep?

Answer 7

It is a common bacterium that lives in the body without causing harm to healthy people, anyone can be a carrier of GBS

Question 8

Where does Group B Strep develop?

Answer 8

In the intestine, rectum and vagina in 25% of pregnant women

Question 9

How do you diagnose Group B Strep?

Answer 9

• Vaginal and Rectum swab

Question 10

Treatment for GBS?

Answer 10

• Treating women with risk factors and with confirmed GBS with antibiotics during labour (ideally 4 hours before birth)
• Swab can be taken at 35 - 37 weeks

Question 11

What is the concern with group B strep in pregnancy?

Answer 11

• Not dangerous to the woman but is for the neonate
• Can be passed from mother to baby during labour
• Passed onto baby causing infection that can be very aggressive

Question 12

Risk factors for GBS

Answer 12

• Previous baby with GBS
• UTI with GBS in pregnancy
• Positive GBS screening
• Preterm labour
• Preterm pre labour rupture of membranes
• Prolonged rupture of membranes
• Signs of infection in labour

Question 13

What is early onset infection?

Answer 13

• Develops usually within 24 hours after birth

Question 14

What is late onset infection?

Answer 14

Develops within 7 days until 3 months of age

Question 15

Sefina, 30 weeks pregnant had a vaginal swab that shows Group B Strep infection. Your plan is to:

Answer 15

Inform Sefina that the recommendation is to repeat the swab at 35 - 37 weeks of pregnancy.

Question 16

Which women should be offered Group B strep prophylaxis in labour?

Answer 16

Women in preterm labour (<37 weeks) whose cervix is dilating.