Neonatal and childhood infections Flashcards
The mnemonic TORCH can be used to remember common congenital infections. What does it stand for?
Toxoplasmosis Other (HIV/HBV) Rubella CMV HSV
Describe the aetiology of congenital infection
Transmission from mother
TORCH can also stand for the non-specific features of congenital infection presentation. List these presenting features
Thrombocytopaenia Other (ears/eyes - cataracts, choroidoretinitis) Rash Cerebral abnormality (eg microcephaly) Hepatosplenomegaly
How are congenital infections diagnosed?
Serology
How are congenital infections prevented?
TORCH screen for antibodies in pregnant mothers/women planning a pregnancy NB This screening test is more commonly performed on neonates, but at that point is no longer a preventative measure
List 3 organisms responsible for early onset neonatal sepsis
Group B Strep E. coli Listeria
List 3 maternal factors that can cause early onset neonatal sepsis
PROM Fever Foetal distress
List 3 fetal factors that can cause early onset neonatal sepsis
Respiratory distress Acidosis Asphyxia
How does early onset sepsis present?
Fever Generally unwell - similar to neonatal meningitis
Neonatal sepsis is diagnosed using a “septic screen” of tests. What does this include?
FBC CRP Blood culture Deep ear swab CSF Surface swab CXR
What is the treatment for early onset neonatal sepsis?
ABC Supportive Nutrition Antibiotics: BenPen + Gentamicin OR if listeria suspected, Amoxicillin/Ampicillin
In what time frame would neonatal sepsis be diagnosed as late onset?
48 hrs - 6 weeks after birth
List 4 organisms responsible for late onset neonatal sepsis
Coag -ve staph (eg epidermis) Group B Strep E. coli Listeria
How does late onset neonatal sepsis present?
Bradycardia Apnoea Poor feeding Irritability Convulsions Jaundice Respiratory distress Focal inflammation (examine umbilicus)
How is late onset neonatal sepsis diagnosed?
Septic screen + urine culture
What is the first line antibiotic treatment for late onset neonatal sepsis?
Flucloxacillin + Gentamicin
What is the second line antibiotic treatment for late onset neonatal sepsis (if child v ill)?
Tazocin + Vancomycin
What is the antibiotic treatment for late onset neonatal sepsis in the community?
BenPen + Amoxicillin + Cefotaxime (to cover listeria and community meningitis)
Which 2 viruses commonly cause childhood infection and how can this be complicated?
VZV HSV Complication: Secondary bacterial infection
How does childhood infection usually present?
Non-specific: fever, abdo pain
How is childhood infection diagnosed?
FBC CRP Blood/urine/sputum culture
Which organism most commonly causes bacterial meningitis in children under 3months
Haemophilus influenzae
Which organism most commonly causes bacterial meningitis in children >3 months old?
Neisseria meningitidis
Which organism also causes bacterial meningitis in children under 2 years old?
Streptococcus pneumoniae
Which organisms also commonly cause bacterial meningitis in children 1-3 months old?
GBS E coli Listeria (Therefore empirical antibiotics at this age should include amoxicillin)
In the young, respiratory infections are usually viral. At what age are bacterial resp infections possible, and which should be considered?
>4 years S. pneumoniae and mycoplasma
List 4 organisms that cause UTI in children
E. coli (most common) Proteus Klebsiella Enterococcus
How are UTIs diagnosed in children?
Culture (>10^5 cfu/ml) Microscopy: pyutia (pus cells) Clinical symptoms
