Sepsis Flashcards
Neonatal Septicemia
Neonatal Septicemia )
Definition: Clinical syndrome characterized by systemic illness with decumentation
of infection (multiplication of bacteria with their toxins in the blood)
Etiology
Bacterial infections are the most common cause of sepsis in newborns. Bacteria such as
— E. coli,
— Listeria monocytogenes and
— Group B streptococcus (GBS) are common bacteria that can cause infections that lead to sepsis.
**Viruses, fungi and parasites can also lead to the condition.
Pathophysiology
Pathogenesis
Risk factors
Pathophysiology. Mainly caused by ascending infection in the mother with chorioamnionitis, perinatally via direct contact in the birth canal and haematogenous spread.
The main micro-organisms associated with EONS include;
— GBS— group B streptococci
— E- coli,
— Coagulase-negative Staphylococcus,
— H influenzae and
— Listeria monocytogenes (4).
Pathogenesis
Early sepsis
Onset— In the 1st week
Risk Factors—
1- Prematurity
2- Premature rupture of membranes > 18 hr.
3- Chorioamnionitis: is an infection of the placenta and the amniotic fluid.
4- Maternal intrapartum fever> 37.5 °C.
5- Maternal bacteriuria.
Organisms—
1- Group B streptococci (GBS)
2 - E.Coli
3- Listeria monocytogenes
4- Others: - Hemophilus influenza
- Klebsiella
Late and nosocomial sepsis
Onset— After the 1st week
Risk Factors—
1- Prematurity.
2- Hospitalization
3- Umbilical catheterization 4- Endotracheal intubation 5- Mechanical ventilation. 6- Other disorders:
- Meningeomyelocele
- Tracheosphageal fistula
- Congenital heart diseases - Intracranial heamorrh_g_e.
Organisms—
1- Staphylococcus Aureus.
2- Hemophilus influenza
3- Klebsiella.
- Pseudomonas.
- Viral or candida
Signs and Symptoms / Clinical picture
Clinical picture
1- Presence: of one or more risk factors espicially in premature or mechanically
ventilated baby with persistant metabolic acidosis should suspect sepsis until
prove otherwise. (antibiotics must be used till negative cultures are obtained).
2- Early manifestations => Non specific =not doing well baby
- Respiratory distress and apneic attacks.
-Lethargy
- Poor feeding and vomiting
- Unstable temperature (mainly hypothermia)
- Poor Moro and suckling reflexes
3- Late manifestations = focal infections
- Respiratory=> Pneumonia with respiratory distress(tachypnea,retractions,…)
- Neurologic=>Meningitis:
- Seizures
- Tense bulging fontanelle
- High pitched cry
- Irregular respiration
- Hypotonia & hyporeflexia
*Cardiac:
-Shock-+ pallor, cold skin, hypotension, oliguria
- Heart failure-+ tachycardia, tachypnea, tender liver, cardiomegaly
*Gastrointestinal:
-Vomiting, diarrhea.
- Direct hyperbilirubinemia due to hepatitis.
- Hepatosplenomegal
-Necrotizing enterocolitis.
- Heamtologic:
- Pallor
- Purpura / DIC
-Bleeding tendency
*Skin: Sclerema =hardening ofthe skin-+ poor prognosis.
Investigations
Investigations
1· Sepsis screen :Septicemia is suggested when:
i- CBC: show
-Leucopenia< 5000/mm3 & neutrophil count< 1000/mm3 (with severe sepsis) -Toxic granulations in neutrophils.
- Bandemia: Band cells (immature)>20% oftotal neutrophil count.
- Less commonly leucocytosis (> 25.000 I mm3)
ii- Markers of inflammation:
- Serial determination ofC-reactive protein (CRP) -ESR
- Haptoglobin
2- Identification ofthe causative organism
- Blood cultures over aerobic & unaerobic media.
- Cultures ofCSF, urine, stool and endotracheal aspirate.
- Detections ofGBS or E-Coli antigens in CSF by latex agglutination.
3· Detect foci of infection
1- Chest x ray for pneumonia.
2- Lumbar puncture:
* Biochemical: CSF analysis in neonatal meningitis show:
- Increased cells, protein , pressure
- Decreased glucose.
* Culture and gram stain
Management
Parenterally means— the route by which a drug is administered) by means other than through the digestive tract, esp by injection. designating a drug to be injected. True or false?
Parenteral nutrition, often called total parenteral nutrition, True or false?
Perenteral nutrition is the medical term for infusing a specialized form of food through a vein (intravenously).
And. The goal of the treatment is to correct or prevent malnutrition. True or false?
Management
Prophylaxis: Maternal intrapartum ampicillin if there is risk factors. Curative:
1· Incubator care in neonatal intensive care unit (NICU): for
- Slow rewarming
- Support respiration:
- 0 2 inhalation
-Mechanical ventilation
- Support circulation:
-I.V. fluids
-Packed red blood cell transfusion.
-Fresh plasma transfusion.
-Dopamine infusion.
- Support nutrition:
-Prolonged cases need total parenteral nutrition
2- Specific treatment:
* Immediate parenteral antibiotics is initiated after taking appropriate cultures.
* Antibiotics are given according to culture and sensitivity.
* While waiting for culture results ; empiric antibiotic combinations is given:
- Ampicillin: 100 mg /kg /dose every 12 hours.
- Gentamicin: 5 mg/kg/day divided every 12 hours
- Third generation cephalosporin(cefotaxime) can be added for critically ill.
*All antibiotics should be given parenterally for 2-3weeks .
3- Immunotherapy: (Controversial benefits)
1- Exchange transfusion.
Value:
- Remove bacteria, toxins, inflammatory mediators.
- Supply antibodies & platelets.
2- Intravenous immunoglobulin.
3- Granulocyte transfusion.
4- Granulocyte colony stimulating factor (G-CSF).
5- Granulocyte-monocyte colony stimulating factor (GM-CSF).
4- Treatment of complication
True— Parenterally means— the route by which a drug is administered) by means other than through the digestive tract, esp by injection. designating a drug to be injected.
True
True
