Neonatal sepsis Flashcards
Types of neonatal sepsis
Early onset sepsis 48 hrs of life
due to organism acquired around the time of birth or in hospital e.g. Coag Neg Staph in NICU
Male predominance affect
Mortality rate is 5% mainly
Risk factors for late onset neonatal sepsis
Prolonged hospitalisation eg preterm in NICU
Presence of foreign bodies e.g. IV cannula or ends-tracheal tube
Cross infection by staff and parents
Malformation eg UT anomalies, vesicoureteric reflux, neural tube defects
Signs of a seriously illness neonate
Fever - >38 need full sepsis evaluation and admission
Feeding - volume in last 24hr less than 50% of normal (150ml/kg/day)
Urine output - 20seconds
Vomiting - in excess of normal post-feed positing.
Severe jaundice - Risk of bilirubin encephalopathy, particularly if haemolytic
Hypothermia
temperature instability
Poor handling
Hypo or hyperglycaemia
Bradycardia episodes
Signs of decreased peripheral circulation in an neonate
generalised pallor of recent onset
Mottling
Cold periphery
Sluggish capillary return
Signs of respiratory distress
↑RR >60/min, Recession
Expiratory grunt, nasal flaring, cyanosis
Types of apnoea
Central eg premature baby - tx with caffeine
Obstructive eg URTI with pharyngeal mucous, gastro-oesophageal reflux, Blocked nose
Combined
Common cause of bile-stained vomit in neonates
bowel obstruction e.g. malrotation with volvulus
Septic work up in a neonate
Blood cultures CRP - raised after 12 hr FBC - Neutropenia very bad sign Venous blood gas True blood glucose LP- CSF
Mx of neonate with suspected of neonatal sepsis
Admit or transfer to special care nursery
Supportive care may include
Monitoring O2 sats, HR, BP
Humidicrib, Phototherapy
Resus - 10-20ml/kg bolus
Correction fluid, electrolyte, glucose, haematological derangements
Withhold enteral feeding in infant is unstable.
Antibiotics - always say that you would look up the guidelines
Antibiotics for early onset neonatal sepsis
Benzylpenicillin (double the dose if meningitis suspected) + Gentamicin. IV or IM
if possibility of Listeria use Ampicillin instead of penicillin
Antibiotics for late onset neonatal sepsis
Flucloxacillin + Gentamicin
Septic shock due to gram negative organism - Vancomycin +/- gentamicin
Meningitis - Ampiciliin +Cefotaime
Cx antibiotic use in neonates
Necrotizing enterocolitis - triple therapy - Ampicillin, gentamicin, plus metronidazole
Duration of antibiotic use in neonates sepsis
stop when - low likelihood of infection plus baby in good condition plus negative infective indices or if culture are negative after 48hrs
If cultures are neg but baby is still sick continue for at least 5 day
Sepsis of gram neg - tx for 10 days
GBS - tx 10days
Meningitis 14 to 21 days
UTI 5-10 days
Risk factors for Early onset GBS
Prolonged rupture of membranes ( >18 hours)
Fetal distress
Maternal pyrexia ( >38)
Maternal overt infection eg UTI, gastroenteritis /diarrhoeal illness
Multiple obstetric procedures, cervical sutures
Preterm delivery
History of GBS infection in previous infant
GBS bacteriuria in this pregnancy
What steps can be taken to reduce risk of early onset GBS
Not recommended in low risk women. Risk based approach in recommended.
If risk factors present then intrapartum antibiotics are reccommended
When is a swab indicated to look for GBS.
Low vaginal and rectal swab is recommended
PROM >18 hr
PPROM
Mx of neonate with mother of GBS positive or suspected or had risk factors
Observe for signs of sepsis, temp, Pulse and RR every 4 hrs
Ix - FBC, BC, LP CXR
Tx - Abx regardless of intrapartum Abx if clinical signs of infection, Mother had suspected chorioamnionitis (>38 intrapartum or within 24hr), Mother with previous baby with early onset GBS disease.
What Abx to use in early onset neonatal sepsis
Benzylpencilin 60mg/kg/dose 12hrly IV with slow push.
and gentamicin 2.5mg/kg/dose 36 wks every 24hrs
Can use ampicillin instead of Benzylpencilin
Discharge Criteria for a neonate recovering from sepsis
Consider parental ability to understand and follow instructions including
recognise and respond appropriately to signs of infection in the baby
Communicate with health-care providers by telephone
Transport the baby promptly to an appropriate health care facility if required
What intrapartum antibiotic do you give for a mother with maternal risk factors for GBS
Commence after onset of labour aiming for at least 4hrs prior to birth.
Loading dose of benxylpenicillin 1.2g IV
Maintenance dose - Benzylpenicllin 600mg IV every 4hr until birth. Commence 4 hrs after loading dose.
If penicillin allergy - Lincomycin or clindamycin
