Late-Onset Infection ✅

Question 1

How is late-onset neonatal infection acquired?

Answer 1

Either nosocomial (hospital acquired) or community acquired, from the environment or caregivers

Question 2

What is the most common pathogen causing late-onset neonatal infection?

Answer 2

GBS

Question 3

What is late-onset GBS infection more often associated with, compared to early-onset?

Answer 3

Meningitis

Question 4

In what % of cases does late onset GBS infection cause recurrent infections?

Answer 4

1% of cases

Question 5

What is the most common cause of late-onset sepsis in VLBW (very low birth weight) infants?

Answer 5

Coagulate negative staphylococcus (CONS)

Question 6

Why is CONS a particularly dangerous pathogen?

Answer 6

It is known to produce a biofilm that facilitates adherence to lines and catheters, and diminishes host immune response and antibiotic effectiveness

Question 7

What strategies can be employed to reduce the risk of late onset sepsis in preterm infants?

Answer 7

• Strict infection control measures, including strict compliance with hand hygiene
• Strict asepsis during invasive procedures
• Minimising breaches in skin integrity
• Judicious use of parenteral nutrition
• Promotion of enteric feeding with mothers milk
• Rational use of antibiotics
• Limiting dexamethasone and H2 blocker therapy

Question 8

Give an example of an invasive procedure where it is particularly important to adhere to strict asepsis in preterm infants?

Answer 8

Insertion and subsequent care of central lines and catheters

Question 9

Give 4 examples of when there may be breaches in skin integrity in preterm infants?

Answer 9

• Electrodes
• Tape
• Venepuncture
• Heel pricks

Question 10

Why should judicious use of parenteral nutrition be employed in preterm infants?

Answer 10

Prolonged use increases infection risk as it requires central vascular access, and intralipids enhance the growth of lipophilic organisms

Question 11

Why do intralipids in parenteral nutrition enhance the growth of lipophilic organisms?

Answer 11

They impair the function of white cells

Question 12

What is involved in the rational use of antibiotics?

Answer 12

Reducing the use of broad spectrum antibiotics

Question 13

Why is it important to reduce the use of broad spectrum antibiotics in preterm infants?

Answer 13

As they encourage the emergence of antibiotic resistance and fungal sepsis

Question 14

What is the ideal scenario for antibiotic choice?

Answer 14

Narrow spectrum, and guided by culture sensitivity results

Question 15

What plays an important role in the development of normal immune defences in the newborn?

Answer 15

The gut

Question 16

How does the newborns gut play an important role in the development of normal immune defences?

Answer 16

Through complex interaction between gut flora and mother’s milk, with secretory IgA and other immunological factors, and gut-associated lymphoid tissue

Question 17

What protects against invasion of the gut mucosa by pathogenic organisms?

Answer 17

• The establishment of normal gut flora following vaginal birth
• Breastfeeding

Question 18

When is gut colonisation abnormal in neonates?

Answer 18

• Following C-section
• With milk feeding
• After antibiotic treatment

Question 19

How can the risk of neonatal sepsis and necrotising enterocolitis theoretically be reduced in bottle fed infants?

Answer 19

The use of pre- and probiotics, as well as other immunological components such as lactoferrin

Question 20

Why are probiotics not used as standard?

Answer 20

Because although many studies have been conducted, they have not been shown to be beneficial