Management of the Infant At Increased Risk Of Sepsis Flashcards
What is the incident of early onset GBS disease
2 per 1000 in the absence of intra-partum prophylaxis
What is the fatality of early onset GBS disease
2-13%
What are the recommendations for investigating and managing GBS in pregnant women
Screen every women at 35-37 weeks
Treat GBS positive women with penicillin antibiotics in labour, 4 hours before delivery
What is the risk of invasive early-onset GBS disease a baby whose GBS positive mom did not receive antibiotics
1%
What proportion of babies with invasive early onset GBS disease are symptomatic at birth?
75%
What percentage of neonates with invasive early onset GBS disease present within 24 hours?
The rest?
95%
4% present at 24-48 hours
1% present > 48 hours
What do you do with a well-appearing baby with a GBS positive mom appropriately treated?
Why?
Observe til 24 hours and discharge with advise to return if unwell and ability to transport back.
Because there are infants who get GBS sepsis despite IPA. They are likely to present within 24 hours of life
What do you do with a well appearing neonate with a GBS positive mom, who did not receive appropriate IAP
CBC
Vitals Q4H x 24 hours
Advise to return if unwell and transport. Can only be discharged then if parents can comply.
Other than GBS, who else should get IPA?
ROM over 18 hours
Pyrexia (38)
Premature labour (37wks)
Bacteriuria with GBS at any point in pregnancy
Previous infant with invasive GBS disease
What do you do with a well appearing neonate from a GBS negative mom with other risk factors
A limited evaluation: exam at 24 hours, vitals Q4H and CBC
Does the approach of a well appearing neonate born less than 37 weeks differ?
Why?
Yes.
Do not discharge before 48 hours.
Well appearing - limited evaluation
Almost all children will present before 48 hours
How do you clinically diagnose chorioamnionitis?
Fever
Uterine tenderness
Left shift
Foul discharge
What is the risk of sepsis from a mom with chorioamnionitis?
8%
Who gets a full diagnostic evaluation?
- Unwell infant: temperature instability, tachycardia, tachypnea, poor perfusion, respiratory distress
2 Positive limited screen with WBC
What is a full diagnostic evaluation?
BCX
LP
CBC
or CXR
What is a limited diagnostic evaluation:
Vitals Q4H x24 hours
CBC
What are the most common organisms causing early-onset neonatal sepsis?
Other organisms?
Most common: GBS
Other: Other streptococci E. coli Other gram negative organisms (klebsiella, citobacter, enterobacter seratia, pseudomonas) Listeria
What are you looking for on the LP?
Pleocytosis
Low glucose in serum
What are you looking for on the LP?
Pleocytosis
Low glucose in serum
What antibiotics would you choose for the different pathogens?
GBS - ampicillin (or penicillin) and gentamicin
Listeria - ampicillin and gentamicin
Gram negative - ampicillin and cefotaxime
What antibiotics would you choose for the different pathogens?
GBS - ampicillin (or penicillin) and gentamicin
Listeria - ampicillin and gentamicin
Gram negative - ampicillin and cefotaxime
If the kid was too stable for an LP, which antibiotic should you choose?
Ampicillin and gentamicin
If mom is penicillin allergic and receives a different antibiotic, is that ok?
There is insufficient evidence to support the use of alternative antibiotics and these kids should be considered not covered
What’s the difference between possible and definite chorioamnionitis?
Possible: fever
Definite: fever, uterine tenderness and left shift
