Neonatology - Neonatal Sepsis

Question 1

What are the most common causative organisms in neonatal sepsis?

Answer 1

Group B streptococcus
Escherichia coli
Listeria monocytogenes
Klebsiella pneumoniae
Staphylococcus aureus

Question 2

Where is group B strep commonly found?

Answer 2

Vagina

Transferred during labour which can cause sepsis

Question 3

If mothers have GBS what is done to prevent transmission?

Answer 3

Prophylactic antibiotics

Question 4

What are the risk factors for neonatal sepsis?

Answer 4

• Vaginal GBS colonisation
• GBS sepsis in previous baby
• Maternal sepsis, chorioamnionitis or fever >38
• Prematurity
• Early rupture of membrane
• Prolonged rupture of membranes

Question 5

What are the clinical features of neonatal sepsis?

Answer 5

• Fever
• Reduced tone and activity
• Poor feeding
• Respiratory distress or apnoea
• Vomiting
• Tachycardia or bradycardia
• Hypoxia
• Jaundice within 24 hours
• Seizures
• Hypoglycaemia

Question 6

What are the red flags of neonatal sepsis?

Answer 6

• Confirmed or suspected sepsis in mother
• Signs of shock
• Seizures
• Term baby needing mechanical ventilation
• Respiratory distress more than 4 hours post birth
• Presumed sepsis in another baby in multiple pregnancy

Question 7

What are the NICE guidelines for treating for presumed sepsis?

Answer 7

• If one risk factor or clinical feature, monitor observations and clinical condition for 12 hours
• Two or more risk factors or clinical feature of neonatal sepsis - start antibiotics
• Start antibiotics if 1 red flag
• Give antibiotics within 1 hour of deciding them
• Take blood cultures before antibiotics
• Check baseline FBC and CRP
• LP if features of meningitis

Question 8

What antibiotics should be given for neonatal sepsis?

Answer 8

First line
Benzylpenicillin + Gentamycin

Or
Cefotaxime in lower risk babies

Question 9

What ongoing management should be done for neonatal sepsis?

Answer 9

Check CRP again at 24 hours and check blood culture at 36 hours

Consider stopping antibiotics if baby is well, blood cultures negative at 36 hours and both CRP less than 10

Check the CRP again at 5 days if still on treatment

Consider stopping antibiotics if baby is well, LP and blood cultures negative and CRP normal at 5 days

Consider LP if CRP more than 10