Neonatal Sepsis and Hypoglycaemia

Question 1

Possible routes for neonatal infection (4)

Answer 1

trans-placental:

• toxoplasma
• treponema
• listeria
• plasmodium
• rubella
• CMV

ascending maternal infection or chorioamnionitis:

peri-natal infection via haematogenous/genital route:

• HIV
• HZV
• HBV
• chlamydia

post-natal infection via breastfeeding

Question 2

Causes of early onset neonatal sepsis-<72h (5)

Answer 2

trans-placental or ascending infection from cervix:

• GBS
• E.coli
• HiB
• Listeria
• coagulase -ve staph (epidermidis)

Question 3

Features of GBS (4)

Answer 3

gram +ve

frequently colonises female genital tract and neonatal URT and GI tract.

in women it causes asymptomatic bacteruria, UTI, upper genital tract infection, puerperial sepsis, endometritis, pneumonia and bacteraemia w. no focus

not all women screened

Question 4

Criteria for Abx Rx for GBS in pregnant women (4)

Answer 4

Rx w. intrapartum IV benpen if:

• previous child w. GBS sepsis
• +ve swab during this pregnancy
• maternal fever
• GBS bacteruria in this pregnancy, even if treated

Question 5

RFs for early onset neonatal sepsis (8)

Answer 5

Major RFs:

• sepsis in other baby in twin pregnancy
• antibiotics given to mother during labour (not for GBS)

minor RFs:

• premature rupture of membranes
• prolonged rupture of membranes: 18h in preterm, 24hr in term
• prematurity
• previous baby infected w. GBS
• maternal GBS colonisation in current pregnancy
• chorioamnionitis/maternal fever

Question 6

Presentation of early onset neonatal sepsis (15)

Answer 6

major:

• resp distress >4h after birth
• mechanical ventilation
• signs of shock
• seizures

minor:

• change in behaviour/responsiveness
• change in tone
• CPR
• oliguria
• acidosis
• feeding difficulties
• abnormal HR
• hypoxia
• jaundice <24hr
• encephalopathy
• fever

Question 7

Mx of early onset neonatal sepsis (2)

Answer 7

if 1 major RF or 2 minor RFs, start IV benpen+gent if suspicious of neonatal sepsis

also perform full septic screen

Question 8

Causes of late onset neonatal sepsis->72hr (6)

Answer 8

staph aureus-commonest

coagulase -ve staph (epidermidis)

E.coli

pseudomonas

listeria

klebsiella

Question 9

Complications of late onset neonatal sepsis (9)

Answer 9

hypoxaemia

RDS

jaundice

neonatal encephalopathy

tachycardia

tachypnoea

pulmonary HTN

apnoea

poor feeding

Question 10

Red flags in late onset neonatal sepsis (4)

Answer 10

RDS >4h after birth

seizures

mechanical ventilation

signs of shock

Question 11

Rx of late onset neonatal sepsis

Answer 11

benpen+gent for 10-14d

Question 12

Neonatal infection screen (6)

Answer 12

FBC:

• WCC >15 (12 for adults)
• low platelets

U+Es

blood, urine, stool culture

LP

ENT/other swabs for infection

CXR if resp signs

Question 13

Predictive signs for severe illness at <1wk old (11)

Answer 13

stiff limbs

seizures

lethargy

grunting

movement only when stimulated

T>37.5 or <35.5

cyanosis

chest wall indrawing

cap refill>3s

difficulty feeding

RR>60

Question 14

Signs of neonatal hypoglycaemia (2)

Answer 14

jitteriness

hypotonia

Question 15

RFs for neonatal hypoglycaemia (7)

Answer 15

maternal DM

maternal labetalol

hypothermia

prematurity

neonatal sepsis

inborn errors of metabolism

IUGR