Neonatal sepsis

Question 1

Types of neonatal sepsis

Answer 1

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

Question 2

Risk factors for late onset neonatal sepsis

Answer 2

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

Question 3

Signs of a seriously illness neonate

Answer 3

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

Question 4

Signs of decreased peripheral circulation in an neonate

Answer 4

generalised pallor of recent onset
Mottling
Cold periphery
Sluggish capillary return

Question 5

Signs of respiratory distress

Answer 5

↑RR >60/min, Recession

Expiratory grunt, nasal flaring, cyanosis

Question 6

Types of apnoea

Answer 6

Central eg premature baby - tx with caffeine
Obstructive eg URTI with pharyngeal mucous, gastro-oesophageal reflux, Blocked nose
Combined

Question 7

Common cause of bile-stained vomit in neonates

Answer 7

bowel obstruction e.g. malrotation with volvulus

Question 8

Septic work up in a neonate

Answer 8

Blood cultures
CRP - raised after 12 hr
FBC - Neutropenia very bad sign
Venous blood gas
True blood glucose
LP- CSF

Question 9

Mx of neonate with suspected of neonatal sepsis

Answer 9

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

Question 10

Antibiotics for early onset neonatal sepsis

Answer 10

Benzylpenicillin (double the dose if meningitis suspected) + Gentamicin. IV or IM
if possibility of Listeria use Ampicillin instead of penicillin

Question 11

Antibiotics for late onset neonatal sepsis

Answer 11

Flucloxacillin + Gentamicin
Septic shock due to gram negative organism - Vancomycin +/- gentamicin
Meningitis - Ampiciliin +Cefotaime

Question 12

Cx antibiotic use in neonates

Answer 12

Necrotizing enterocolitis - triple therapy - Ampicillin, gentamicin, plus metronidazole

Question 13

Duration of antibiotic use in neonates sepsis

Answer 13

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

Question 14

Risk factors for Early onset GBS

Answer 14

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

Question 15

What steps can be taken to reduce risk of early onset GBS

Answer 15

Not recommended in low risk women. Risk based approach in recommended.
If risk factors present then intrapartum antibiotics are reccommended

Question 16

When is a swab indicated to look for GBS.

Answer 16

Low vaginal and rectal swab is recommended
PROM >18 hr
PPROM

Question 17

Mx of neonate with mother of GBS positive or suspected or had risk factors

Answer 17

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.

Question 18

What Abx to use in early onset neonatal sepsis

Answer 18

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

Question 19

Discharge Criteria for a neonate recovering from sepsis

Answer 19

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

Question 20

What intrapartum antibiotic do you give for a mother with maternal risk factors for GBS

Answer 20

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