Neonatal Sepsis

Question 1

Why are neonates relatively immunocompromised?

Answer 1

Low levels of IgG (decreases with gest age)
Neutrophils - are not functional, also macrophages

Question 2

Timing of neonatal infections

Answer 2

Early - Birth to 3 days - from maternal genital tract

Late - 4 days to 30 days
Late Late - >30 days to 3 months

Question 3

Congenital sepsis - infections?

Answer 3

CMV
Syphilis
Rubella
Enteroviruses
GBS
HIV
Toxo
HSV
Neisseria Gonorrhoea

Question 4

Late onset sepsis in neonate - common pathogens?

Answer 4

• staph aureus, Coag negative staph, group B strep - more common in developed
  -Gram negatives (much more likely to die from this) - more common in developing
  -Fungal!

Question 5

Most important gram negative organism causing neonatal sepsis? (two)

Answer 5

Klebsiella
Ecoli

Question 6

Most common gram positive organisms causing neonatal sepsis?

Answer 6

Staph aureus (MAIN), coag neg staph (IF REMAINS IN HOSPITAL), group B strep, listeria

Question 7

3 Main pathogens causing neonatal sepsis?

Answer 7

Klebsiella
Ecoli
Staph aureus (add in coag neg staph if not discharged)

Question 8

Neonatal pneumonia cause of severe case?

Answer 8

Group B strep
Staph aureus
(Gram positives)

Question 9

Causes of neonatal meningitis?

Answer 9

GBS
Ecoli

Question 10

What to do if a neonate has neonatal meningitis?

Answer 10

Repeat LP at 48 hrs to confirm negative culture
(For gram negatives repeat at end of therapy)

Question 11

Duration of Rx in neonatal sepsis?

Answer 11

2 weeks gram positive organism
3 weeks gram negative organism
If no organism - 3 weeks

Question 12

Causes of cerebral abscess in newborn?

Answer 12

1. Cronobacter sakasakii
   (Enterobacter sakasakii)
2. Citrobacter diversus
3. Serratia marcescens

Question 13

Treatment of neonatal sepsis worldwide? What about if suspect meningitis?

Answer 13

Ampicillin plus gentamicin (early onset)
Ampicillin plus ceftriaxone alternative

Question 14

If high suspicion of staph aureus/coag negative staph causing neonatal sepsis Rx?

Answer 14

Ampicillin + vancomycin (late onset)

Question 15

If suspect or confirmed pseudomonas for neonatal sepsis, desired Rx?

Answer 15

Ampicillin + vancomycin +/-
ceftazidime/cefepime***

Question 16

If no option of IV Rx in neonatal sepsis, option?

Answer 16

IM benpen plus IM gent or PO amoxicillin and IM gent

Question 17

Severe course with pyogenic bacteria causing pneumonia. Organisms?

Answer 17

GBS and S. aureus