infections in the newborn

Question 1

define early onset sepsis and how is it acquired

Answer 1

sepsis presenting <48hrs after birth

Acquired from mother’s birth canal (intrapartum)

Question 2

What are the 3 most common bacteria in early onset sepsis

Answer 2

• group B strep
• E.coli
• Listeria Monocytogenes

Question 3

What are risk factors for early onset sepsis

Answer 3

Obstetric: PROM, Preterm delivery, intrapartum fever
GBS bacteriuria
Previous infant with GBS disease

Question 4

complications of early onset sepsis

Answer 4

• bloodstream infection –> DIC
• Pneumonia
• meningitis

Question 5

Presentation of meningitis in the newborn

Answer 5

non-specific signs

• irritability
• seizures

Question 6

sequelae of neonatal meningitis

Answer 6

deafness, hydrocephalus, poor neurodevelopment

Question 7

Management and treatment of neonatal GBS

Answer 7

Investigations: bloods, cultures, clotting, lumbar puncture
Appropriate abx - benzylpenicillin & gent followed by targeted therapy to culture
CSF coverage if suspect meningitis- cefotaxime (10-14d)

Question 8

Define late onset sepsis and how is it acquired

Answer 8

Sepsis presenting >48hrs after birth usually acquired in hospital

Question 9

How might a neonate get infected with Coag -ve staphylococcus

Answer 9

It can produce a biofilm that sticks to plastic- if a neonate has lines/cannulas etc

Question 10

How is coag -ve staph infection treated

Answer 10

Broad spectrum initially-flucloxacillin & gentamicin

Targeted therapy following culture

Question 11

What organism is the commonest cause of nappy rash and how is it treated

Answer 11

Candida

Treated with local nystatin or miconazole- can use oral treatment too

Question 12

What is the pathogenesis of nec

Answer 12

injury to the mucosa,
substrate for bacteria to multiply in the gut
invasion of the gut wall by bacteria
ileus & perforation

Question 13

How can Hep B be transmitted to babies and how might it be prevented

Answer 13

Vertical transmission during labour (risk about 40%)
Prevention
-If no Hep B e antibodies: Hep B vaccine (4 doses) and Hep B ig (1 dose)
-if Hep B e antibodies: Hep B vaccine (4 dose)

Question 14

How can HIV be transmitted to babies and how can it be prevented

Answer 14

Vertical transmission- transplacental, during labour, breast milk (risk about 25%)
Prevention using anti-retroviral drugs in pregnancy and labour, deliver via c-section and avoid breast feeding

Question 15

classic findings of congenital infections (TORCH)

Answer 15

symmetrical growth restriction
hepatosplenomegaly
thrombocytopenia
rash

Question 16

What does TORCH stand for

Answer 16

Toxoplasmosis
Other (syphilis, VZV, parvovirus B19)
Rubella
CMV
Herpes simplex