Neonatal Sepsis and Meningitis

Question 1

Neonatal sepsis

Answer 1

is a clinical syndrome of

systemic illness accompanied by bacteremia occurring in the first month of life.

Question 2

Early sepsis Pattern

Onset

Answer 2

🧿Acquired before or during delivery (vertical

mother-to-child transmission)

In the 1 st week (usually <72 hr)

Question 3

Risk factors for early onset sepsis

Answer 3

y Prematurity

y Premature rupture of membranes > 18 hr.

y Chorioamnionitis

y Maternal intrapartum fever –„’ y Maternal bacteruria.
-General – socioeconomic status, poor prenatal care,

Question 4

Organisms of early onset sepsis

Answer 4

y 😱😱😱Group B streptococci (GBS)

😱😱😱y E.Coli

y Listeria monocytogenes

Question 5

Late and nosocomial sepsis- general

Answer 5

-Develop after delivery from

organisms acquired in the

hospital or the community

After the 1 st week

Question 6

Late and nosocomial sepsis-risk factor

Answer 6

-y Prematurity.

y Hospitalization

y Umbilical catheterization ,

or poor cord care

y Endotracheal intubation y Mechanical ventilation.
-General – socioeconomic status, poor prenatal care,

Question 7

Late and nosocomial sepsis -organism

Answer 7

-y 😱😱😱Staphylococcus Aureus.

y Hemophilus influenza

y Klebsiella.

y Pseudomonas.

y Viral or candida

Question 8

Early-onset sepsis clinical manifestations

Answer 8

🧿frequently manifested as respiratory failure, shock, meningitis (in 30% of cases), disseminated intravascular coagulation, acute tubular necrosis, and symmetrical peripheral gangrene.
🧿Early manifestations—grunting, poor feeding, pallor, apnea, lethargy, hypothermia, or an abnormal cry—may be nonspecific.
🧿Profound neutropenia, hypoxia, and hypotension may be refractory to treatment with broad-spectrum antibiotics, mechanical ventilation, and vasopressors such as dopamine.
🧿Poor Moro and suckling reflexes

Question 9

Late manifestations

Answer 9

🧿Early manifestations plus more focal infections
🧿Meningitis

🧿Hepatitis Direct hyperbilirubinemia Hepatosplenomegaly

🧿Necrotizing enterocolitis

🧿Sclerema = hardening of the skin ( poor prognostic sign)

🧿Pneumonia

🧿Septic shock / Septic renal failure with oligoanuria and metabolic acidosis

🧿Purpura / DIC

Question 10

Diagnosis of sepsis

Answer 10

1. History : for risk factors
2. Clinical picture
3. Investigations
   a. 😷Sepsis screen: Septicemia is suggested when:

CBC findings

• Leucopenia < 5000/mm 3 (with severe sepsis)
• Toxic granulations in neutrophils.
• Bandemia: Band cells (immature) >20% of total neutrophil count.
• Less commonly leucocytosis (> 30.000 / mm3 )
• Thrombocytopenia Markers of inflammation
• Serial determination of C-reactive protein (CRP)
• ESR
  b. 😷Detect causative organism by
• Cultures of Blood, CSF, urine, and endotracheal aspirate.
  c. 😷Evidence of Multiorgan System Disease

1- Pulmonary: Chest x ray for pneumonia, blood gases

2- CSF analysis, culture and gram stain for meningitis

3- Liver enzymes, bilirubin, ammonia, prothrombin time, PTT

4- Serum urea and electrolytes, blood glucose

Question 11

False negative Blood Culture

Answer 11

 Maternal antibiotics
 Small blood sample
 Bacteria load, timing of sampling

Question 12

Antibiotics For early onset sepsis:

Answer 12

🧿Ampicillin plus Gentamicin
🧿Third-generation cephalosporins such as cefotaxime or ceftazidime are valuable additions for treating documented neonatal sepsis and meningitis
🧿-All antibiotics should be given for 10-14 days (21d for meningitis).

Question 13

Antibiotics For late onset sepsis:

Answer 13

• Vancomycin(as the causetive is staph MRSA) plus Gentamicin
• Third-generation cephalosporins such as cefotaxime or ceftazidime are valuable additions for treating documented neonatal sepsis and meningitis
• All antibiotics should be given for 10-14 days (21d for meningitis).

Question 14

A. Prophylaxis of sepsis

Answer 14

Maternal intrapartum ampicillin prevent perinatal transmission of GBS

Question 15

Curative of sepsis

Answer 15

1. Incubator care in neonatal intensive care unit (NICU) (See before)
2. Specific treatment y Immediate parenteral antibiotics are initiated after taking appropriate cultures.

y Antibiotics are given according to culture and sensitivity(C/S) y While waiting for C/S ; empiric antibiotic combinations is given:

o For early onset sepsis: Ampicillin plus Gentamicin o For late onset sepsis: Vancomycin(or oxacillin) plus Gentamicin o Some experts recommend antifungal prophylaxis with fluconazole for particularly high-risk newborns—that is, those of extremely LBW (<1000 g) and low gestational age (<27 wk).

o Third-generation cephalosporins such as cefotaxime or ceftazidime are valuable additions for treating documented neonatal sepsis and meningitis
2- tx of the complications