Neonatal Spesis Flashcards
When do newborns die?
More than 50% in the first 24hrs of life
More than 75% in the first week of life
What are risk factors for infection?
Most important is prematurity and LBW
Baseline medical condition
Inadequate immune response
Alteration of barriers
Invasive procedures
TPN
Broad spec abx
Prolonged hospitalisation
Virulence of infecting organism
Why are neonates ‘immunocompromised’
IgG concentration depends on gestational age, eg only 1/3 antibodies in a 28weeker
Immunoglobulins depend on previous exposure of Mum
Neutrophils in neonates don’t function very well, they have deficiencies in adherence, aggregation and deformability. They also have lower concentrations of neutrophils
Complement is not transported actively through placenta, it depends on gestational age
How do you categorise neonatal infections?
Early Onset this is brith to 3 days
Late Onset this is 4-30 days
Late Late Onset >30 days
Listeria and GBS can occur up to 3 months
What are risk factors for early vs late vs late late?
Early Onset more affected by obstetric complications,
What are the WHO for severe infection in children?
Convulsions, dorwsy or unconscious
Res distress, grunting
Poor perfusion and weak pulse
Jaundice, poor feeding and abdo distension
Main cause of late onset sepsis in developed countries? How does this compare to developing countires?
Mostly gram positive such as coagulase negative Staphylococcus
Gram negative less common but much higher mortality such as psuedomonas
Exact opposite in developing countries. Gram negative causes all infections. Most importantly Klebsiella then E-Coli.
Main cause of community acquired infections vs hospital acquired infection?
Klebsiella, staph and E-Coli
This is the same for hospital, but you start to see gram positive, coag negative Staphylococcus
What is main cause of Pneumonia in newborn?
Same as neonatal sepsis
Such as GBS or staph Aureus
How many neonates with sepsis have meningitis? Tx time?
1/7 will have meningitis
Need LP!!
Mostly caused by GBS and E-Coli
Repeat LP at 48hrs and if gram negative, repeat LP at end of therapy
2 week abx for gram positive bacteria
3 weeks for gram negative or unknown bacteria
Main pathogens assoc with abscess in newborns?
Cronobacter Sakasakii
Citrobacter Diversus
Serratia Marcescens
Always image these infants!!
First line tx for sepsis? if meningitis?
Ampicillin and Gentamicin
Ampicillin and cefotaxime
2nd line is Ampicillin and Vancomycin
What to do in rural settings?
Injectable gent and benzyl penicillin
Can use oral amoxicillin
