Paeds Emergencies Flashcards

1
Q

What is neonatal sepsis?

A

EARLY onset: <72h since birth
LATE onset: >72h since birth (sometimes >7 days)

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2
Q

Which organisms most commonly cause EARLY onset neonatal sepsis?

A

Acquired via contaminated amniotic fluid or during vaginal delivery:
Group B Streptococcus (75%)
Escherichia Coli
Listeria monocytogenes (less common)

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3
Q

Which organisms most commonly cause LATE onset neonatal sepsis?

A

Acquired from environment post-delivery, normally from parents or HCPs

Group B Streptococcus
Escherichia Coli

Staphylococcus epidermidis
Pseudomonas aeruginosa, Klebsiella, Enterobacter

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4
Q

Which are the 2 most common organisms in both early onset and late onset sepsis?

A

Group B Streptococcus
Escherichia Coli

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5
Q

List 5 risk factors for neonatal sepsis

A

Previous baby with GBS infection
GBS colonisation from prenatal screening
Intrapartum temp. ≥38ºC,
PROM ≥18h
Evidence of maternal chorioamnionitis

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6
Q

Which babies are most commonly affected by neonatal sepsis?

A

Premature (<37w): ~85% of neonatal sepsis cases

Low birth weight (<2.5kg): ~80% are low birth weight

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7
Q

Give 9 signs of neonatal sepsis

A

Respiratory distress (85%)

Tachycardia: common, but non-specific

Apnoea (40%)

Apparent change in mental status/ lethargy

Jaundice (35%)

Seizures (35%): if cause of sepsis is meningitis

Poor/ reduced feeding (30%)

Abdominal distention (20%)

Vomiting (25%)

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8
Q

What are 4 signs of respiratory distress in an infant with neonatal sepsis?

A

Grunting
Nasal flaring
Use of accessory respiratory muscles
Tachypnoea

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9
Q

Why should temperature alone not be used for indication of neonatal sepsis?

A

Term: more likely to be febrile
Pre-term: more likely to be hypothermic

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10
Q

What investigations should be performed in neonatal sepsis?

A

2x Blood cultures: establish dx

FBC: abnormal neutrophil counts (neutrophilia + neutropenia)

CRP: not useful for dx, but sequential assessment will help to guide Mx + progress with Tx. Usually raised

Blood gases: metabolic acidosis is particularly concerning for neonatal sepsis, esp. a base deficit of ≥10 mmol/L

Urine MC+S: rarely +ve in EOS, more useful in LOS. Signs of infection (e.g. raised leukocytes, +ve culture, haematuria, proteinuria) if UTI is the source

Lumbar puncture: if concern of meningitis as source based on clinical features/ as part of septic screen in any baby <28d

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11
Q

What is the management of neonatal sepsis?

A

IV Benzylpenicillin/ Ampicillin + Gentamicin
Repeat CRP at 18-24h

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12
Q

How may neonatal sepsis be prevented?

A

Benzylpenicillin intrapartum abx prophylaxis for:
Previous pregnancy with GBS
Previous baby with early- or late-onset GBS disease
Preterm labour regardless of GBS status
Pyrexia during labour (>38ºC)
Clinical dx of chorioamnionitis
GBS colonisation, bacteriuria or infection during current pregnancy

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13
Q

What is the risk of maternal GBS carriage in a current pregnancy if there has been previous GBS carriage?

A

50%

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