Paeds Emergencies Flashcards
What is neonatal sepsis?
EARLY onset: <72h since birth
LATE onset: >72h since birth (sometimes >7 days)
Which organisms most commonly cause EARLY onset neonatal sepsis?
Acquired via contaminated amniotic fluid or during vaginal delivery:
Group B Streptococcus (75%)
Escherichia Coli
Listeria monocytogenes (less common)
Which organisms most commonly cause LATE onset neonatal sepsis?
Acquired from environment post-delivery, normally from parents or HCPs
Group B Streptococcus
Escherichia Coli
Staphylococcus epidermidis
Pseudomonas aeruginosa, Klebsiella, Enterobacter
Which are the 2 most common organisms in both early onset and late onset sepsis?
Group B Streptococcus
Escherichia Coli
List 5 risk factors for neonatal sepsis
Previous baby with GBS infection
GBS colonisation from prenatal screening
Intrapartum temp. ≥38ºC,
PROM ≥18h
Evidence of maternal chorioamnionitis
Which babies are most commonly affected by neonatal sepsis?
Premature (<37w): ~85% of neonatal sepsis cases
Low birth weight (<2.5kg): ~80% are low birth weight
Give 9 signs of neonatal sepsis
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%)
What are 4 signs of respiratory distress in an infant with neonatal sepsis?
Grunting
Nasal flaring
Use of accessory respiratory muscles
Tachypnoea
Why should temperature alone not be used for indication of neonatal sepsis?
Term: more likely to be febrile
Pre-term: more likely to be hypothermic
What investigations should be performed in neonatal sepsis?
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
What is the management of neonatal sepsis?
IV Benzylpenicillin/ Ampicillin + Gentamicin
Repeat CRP at 18-24h
How may neonatal sepsis be prevented?
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
What is the risk of maternal GBS carriage in a current pregnancy if there has been previous GBS carriage?
50%