Neonatal Sepsis

Question 1

What is early onset neonatal sepsis?

Answer 1

Sepsis in the first 48-72 hours (3 days) of life

Question 2

What are causes of neonatal sepsis? Organisms? Most common?

Answer 2

Ascending infection in mother with chorioamnionitis, via direct contact in the birth canal or haematological spread

Group B Streptococcus - Strep agalatctiae - most common
E. coli
Coagulase negative staphylococcus - staph epidermis
H. influenza
L. monocyotgenes

Question 3

How is neonatal sepsis prevented mothers?

Answer 3

Intrapartum IV antibiotics - ampicillin/penicillin/benzylpenicillin

Previous GBS
Pyrexia during labour
Preterm labour

Question 4

What are risk factors for neonatal sepsis?

Answer 4

Invasive GBS infectino in previous baby
Maternal GBS colonisation, bacteruria or infection in current pregnancy
Prelabour rupture of membranes
Preterm birth following spontaneous labour (<37w)
Suspected or confirmed rupture of membranes more than 18h in preterm birth
Intrapartum fever higher than 38 or confirmed/suspected chorioamnionitis

Question 5

What are clinical indicators suggestive of infeciton?

Answer 5

Altered responsiveness
Floppiness
Feeding difficulties
Feed intolverance - vomiting, abdominal distension
Abnormal HR
Signs of repisratory distress
Hypoxia
Jaundice in 24h
Apnoea
Signs of neonatal encephalopathy
CPR required
Mechanical ventilation in preterm baby
Temperature abnormality
Oliguria
Altered glucose homeostasis
Metabolic acidosis

Question 6

Red flags

Answer 6

Siezures
Signs of shock
Need for mechanical ventilation in term baby
RDS > 4h after birth
Suspected or confirmed infection in co-twin
Systemic ABX given to mother for suspected bacterial infection within 24h of birth

Question 7

What Ix?

Answer 7

FBC
CRP
Blood cultures

Swab/culture relevant sources - purulent eye discharge, foul smelling urine

LP for CSF if suspicion of meningitis

Question 8

What Mx?

Answer 8

IV benzylpenicillin with gentamicin
Empirical ABX

Consider stopping abx at 36h if:
Blood culture is negative
Initial clinical suspicion was not strong
Baby’s clinical condition is reassuring with no possible infection indicators
Levels and trends of CRP are reassuring

IF blood culatures are positive continue for 7-10 days and 14d if LP is positive