Neonatal Sepsis

Question 1

What are the common systemic infections in young infants?

Answer 1

1. sepsis
2. pneumonia
3. UTI
4. meningitis

Question 2

What is neonatal sepsis?

Answer 2

is a clinical syndrome of systemic illness accompanied by bacteraemia
- these are classified as early or late

Question 3

Common bacterial infections include?

Answer 3

1. Streptococcus Pneumonia-Group B
2. Staphylococcus
3. E.coli
   Note: Fungal infections can also cause sepsis

Question 4

Maternal predisposing factors for early bacterial sepsis are?

Answer 4

1. Intrapartum maternal fever during labour
2. Foul smelling amniotic fluid

Question 5

Predisposing labour and delivery factors for bacterial sepsis are?

Answer 5

1. Prolonged Rupture of Membranes
2. Spontaneous Prematurity
3. Born before arrival
4. UTIs
5. Unsterile birthing environment

Question 6

Clinical symptoms of neonatal sepsis?

Answer 6

1. lethargic
2. little movement
3. irritable
4. seizures
5. vomiting

Question 7

ABCCCD clinical signs of neonatal sepsis?

Answer 7

1. grunting, nasal flaring, fast breathing, chest in drawing
2. crepitations in the lungs
3. impaired circulation or shock

Question 8

TPR signs of neonatal sepsis?

Answer 8

1. axillary temperature 37.5 degrees or above (or feels hot to touch) or temperature less than 35.5. degrees
2. fast pulse rate, fast heart rate

Question 9

Clinical signs found in head to toe exam?

Answer 9

1. bulging fontanelle
2. umbilical redness extending to periumbical skin or umbilicus draining pus
3. many skin pustules/big boil (abscess)
4. painful joint, joint swelling, reduced movement and irritability if these parts are handled

Question 10

Supportive management?

Answer 10

1. Ensure warmth
2. Gentle stimulation if apnoeic
3. Respiratory support with oxygen or CPAP if there is severe respiratory distress or oxygen saturations less than 90%
4. If hypoglycaemic, infuse 2mls/kg of 10% dextrose stat
5. Give vitamin K if not received already

Question 11

Septic screening?

Answer 11

1. Lumbar puncture if available, before IV antibiotics
2. Blood culture, if available, before IV antibiotics
3. Urine culture if available
4. FBC: WBC < 5000 or > 20,000/cu mm suggests sepsis

Question 12

Antibiotic management of neonatal sepsis?

Answer 12

1. penicillin
2. cloxacillin
3. gentamicin

Question 13

Rapid assessment of circulation in shock?

Answer 13

1. Cold feet or hands?
2. Capillary refill time > 3 seconds?
   - This is the most reliable sign
3. Fast weak pulse?
4. Not alert?

Question 14

Assessment of dehydration, anemia and malnutrition in shock?

Answer 14

1. Sunken eyes
2. Decreased skin turgor?
3. Pallor
4. Severe wasting/Oedema

Question 15

Steps in Management of shock in neonatal sepsis?

Answer 15

1. insert IV and begin giving fluids
2. start broad spectrum antibiotics
3. if lethargic or unconsious check glucose
   - if low give IV dextrose?
4. give oxygen, make sure child is warm
5. if bleeding apply pressure to stop it
6. send blood for group and cross match if baby has bled e.g. from umbilicus, transfuse quickly
7. if improvement with fluid bolus observe and continue fluids at maintenance rate and give additional if losses

Question 16

Fluid management for shock with impaired circulation but no dehydration/anemia in neonatal sepsis?

Answer 16

1. give 10 mls/kg of Ringers Lactate slowly
   - over one hour: fast bolus may do harm
   - if still has severely impaired circulation after reassesment repeat bolus
2. after 2 boluses (20 mls/kg in total) consider blood transfusion if still shocked
   - use 20 mls/kg of whole blood or 10 mls/kg of packed cells
3. consider CPAP if the respiratory rate has increased from baseline during the boluses
   - as babies may get pulmonary edema