Neonatal Sepsis Flashcards
Sepsis is derived from a Greek word meaning ___________ and ___________
Potentially deadly medical condition
putrefaction ; decay
Neonatal Sepsis
Characterized by a __________ to infection called ___________________________.
It is caused by an ____________ triggered by an infection.
whole body response
SIRS (Systemic inflammatory Response Syndrome)
immune response
4 quick criteria for bedside diagnosis in children:
List them
(any 2)
Elevated HR
Temp
RR
WBC
The term neonatal sepsis refers to the presence in a newborn baby of a ___________________ such as septicemia, pneumonia, meningitis, arthritis, osteomyelitis and UTI with associated SIRS.
bacterial blood stream infection
Sepsis occur when ___________ released into the bloodstream to fight the infection trigger _____________responses throughout the body.
chemicals
inflammatory
Common causes of sepsis in the newborn:
______
__________
___________
Staphylococus epididermidis –CONS
H. influenza
Listeria
Chlamydia
Herpes
Enterobacter
Pseudomonas
Candida
GBS in western countries
Any bacteria cultured from the mother on admission for labor
E. coli
Staph aureus
Klebsella
Pathophysiology of neonatal sepsis
Microbial factors:
Ability to ________ and ________ to host tissues and even plastic polymers used in hosts
Ability to elude ____________ as well as to ___________ action. Ubiquitous character of the organisms
Rapid _________ leading to increased antibiotic resistance
attach ; adhere well
host defenses; antibiotic
Host factors predispose the newborn to sepsis
These factors are especially prominent in the premature infant and involve all levels of host defense, including ____________,________, and ____________
________ immune defenses, and environmental and maternal factors contribute to the risk of neonatal sepsis, morbidity, and mortality.
There may also be a ________ association.
cellular immunity, humoral immunity, and barrier function.
Immature; genetic
Cellular immunity
PMNs are vital for effective killing of bacteria. However, neonatal PMNs are deficient in __________ and __________ capacity.
Decreased __________ to the endothelial lining of blood vessels reduces their ability to __________ and leave the intravascular space to migrate into the tissues.
Once in the tissues, they may fail to __________ in response to chemotactic factors.
chemotaxis ; killing
adherence ; marginate
degranulate
Host factors that predispose newborn to sepsis
Humoral immunity
The fetus has some preformed immunoglobulin, which is primarily acquired through nonspecific placental transfer from the mother.
Most of this transfer occurs in (early or late ?) gestation, so that ________ levels are found with increasing prematurity.
late; lower
Host factors that predispose newborn to sepsis
Barrier function
The physical and chemical barriers to infection in the human body are present in the newborn but are __________ _________.
Skin and mucous membranes are ________________ in the premature infant.
Neonates who are ill, premature, or both are at additional risk because of the invasive procedures that breach their physical barriers to infection.
functionally deficient.
broken down easily
Risk factors for neonatal sepsis:
Maternal UTI, STD, or abnormal serologies
Prolonged _______________ (>____ hrs) ***
_____________ prior to delivery **
Maternal _______________ *
_____________
GBS colonization
Dead 2nd Twin
___________ liquor
Septic __________
_________ _______
Congenital defects/ immune defects Bruised skin
rupture of membranes;24
Maternal fever; chorioamnionitis
Prematurity; Foul smelling
umblicus
Birth Asphyxia
CLASSIFICATION OF NNS
Neonatal Sepsis is of two types:
1. EARLY ONSET SEPSIS (EOS)
• Presents _______ _____ of life.
- LATE ONSET SEPSIS (LOS):
Presents _______ ________ of age.
The source of infection is either _________ or ___________
Within 72 hours
After 72 hours
nosocomial ; community acquired
CLINICAL FEATURES of NNS
• Signs and symptoms of neonatal sepsis are usually NONSPECIFIC:
________ and ___________ episodes for no clear reason, ____________
Lethargy, poor _____, hypo-_______, poor capillary refill. Feeding intolerance, abdominal distention.
• There may be ________ appearance.
Tachypnea, temperature instability, respiratory distress
Apnea and dusky
respiratory distress
Suck; activity
mottling
The full sepsis work-up.
1. FBC differential, platelet count.
2. _________,____________, and ___________ cultures (TRIPPLE TAP).
3. CXR.
4. Equivocal: gastric aspirate for gram stain and culture.
5. Start broad spectrum antibiotics while awaiting culture results.
Blood, urine, and CSF
Tests with high predictive value
B:N >0.2 (____________ to _________ ratio
• WBC <5000 or 20,000
• Mother with suspected or diagnosed _________
• High _________, _________ or _________
• Completing the evaluation: _________ for CSF studies and culture; _________.
immature neutrophils
total neutrophil ratio; chorioamnionitis
CRP; Procalcitonin ; IL-6
Lumbar puncture ; CXR.
Treatment
• Institute _____________ antibiotic coverage for neonatal sepsis. If meningitis is suspected, add _________ to the regimen.
• For premature infants in whom the physical exam may be more equivocal and whose prematurity constitutes an additional risk factor, the threshold for a full sepsis evaluation and antibiotic treatment is much (lower or higher?).
broad spectrum ; cefotaxime
lower.
