Neonatal Sepsis

Question 1

What organisms commonly cause neonatal sepsis?

Answer 1

Group B Streptococcus
E coli
Listeria
S. aureus
Klebsiella

Question 2

What is early onset neonatal sepsis?

Answer 2

Within 72 hours of birth

Question 3

What is late onset neonatal sepsis?

Answer 3

Within 7-28 days of birth

Question 4

What are the risk factors for neonatal sepsis?

Answer 4

Vaginal GBS colonisation
GBS sepsis in a previous baby
Maternal sepsis or chorioamnionitis
Premature rupture of membranes
Prolonged rupture of membranes
Premature neonates
Low birth weight

Question 5

What are the features of neonatal sepsis?

Answer 5

Fever (full term infants)
Hypothermia - pre-term infants
Reduced tone and activity
Poor feeding
Respiratory distress
Vomiting
Tachycardia or bradycardia
Hypoxia
Jaundice within 24 hours
Seizures
Hypoglycaemia

Question 6

What are the differentials of neonatal sepsis?

Answer 6

Hypoglycaemia
Congenital adrenal hyperplasia
Congenital heart disease
Persistent pulmonary hypertension of the newborn
Transient tachypnoea of the newborn
Respiratory distress syndrome
Intraventricular haemorrhage

Question 7

What investigations are used in the diagnosis of neonatal sepsis?

Answer 7

FBC
CRP
Blood culture
Blood gas
Urine MCS
Lumbar puncture if suspected neurological cause
CXR if suspected chest source

Question 8

When should a neonate be treated for sepsis and when should they be monitored?

Answer 8

Monitor a baby with one risk factor or clinical feature
Treat a baby for sepsis if they have 2 or more risk factors or clinical features
- Or if there is a single red flag

Question 9

What are red flag signs that indicate neonatal sepsis?

Answer 9

Confirmed or suspected sepsis in the mother
Signs of shock
Seizures
Term baby needing mechanical ventilation
Respiratory distress starting more than 4 hours after birth
Presumed sepsis in another baby part of multiple pregnancy

Question 10

What is the first line treatment of neonatal sepsis?

Answer 10

IV Benzylpenicillin and gentamicin

Question 11

What alternative antibiotic can be given to babies with neonatal sepsis?

Answer 11

Cefotaxime

Question 12

How should CRP be monitored during treatment in a baby with neonatal sepsis?

Answer 12

Measured 18-24 hours after presentation
Measured at 48 hours
- Antibiotics can be stopped if CRP < 10 and there is a negative culture
Check CRP again at 5 days if still on treatment