Sepsis

Question 1

What is the definition of sepsis, and differentiate between early and late sepsis

Answer 1

EOS - Onset less than 48 hours
- GBS

LOS - Onset more than 48 hours

Question 2

Identify predisposing risk factors that may lead to early and late onset neonatal sepsis

Answer 2

Premature
- immature immune system, thinner skin, multiple procedures
- At 30 weeks infants have half the immunoglobulins a term infant does
- IGM and IGA antibodies transferred in 3rd trimester and nd 4 weeks postpartum respectfully
- often prem babies also lack the passive immunity from mum through breastmilk

Infection
- GBS
- PPROM
- MAS
- maternal pyrexia >38 in labour
- maternal UTI or GI infection
- multiple obstetric procedures
- Invasive procedures eg. IV insertion

Cross infection
- prolonged hospitalisation
- from visitors or staff

Babies with urinary tract anomalies
- ureter reflex

Question 3

Describe the S+S of a septic neonate using a systems approach

Answer 3

CNS - rule out hypoglycaemia or cold stress
- irritability
- lethargy
- high pitched cry
- hypotonia
- hypertonia
- fever
- hypothermia
- seizures
- tremors

RESP - rule out resp distress conditions
- rib retraction
- nassal flaring
- cyanosis
- tachypnoea
- grunting
- apnoea

CARDIAC
- tachycardia
- bradycardia
- arrythmia
- hypertension
- hypotension
- ABG derangement - acidosis, alkalosis

GIT - rule out NEC
- poor feeding
- abdo distension
- loose stools
- hypoglycaemia
- hyperglycaemia
- vomiting - bile stained

SKIN
- pale
- mottled
- jaundice
- peticheal rash - could be DIC

Question 4

What midwifery interventions can minimise the risk of an infant becoming septic (with rationale)

Answer 4

Hand hygeine - 5 moments, bare below elbows etc.

Prophylactic IVABs

Early screening
- blood cultures

Maintaining sterile or individual equiptment

Resiting NGT as per policy

Resiting IV or inserting art line

Assessing skin integrity and VIP regularly

Reducing overcrowding

Introducing breastmilk as early as possible

Educating parents and visitors

Baseline obs

Question 5

What midwifery goals of care and interventions can be implemented to care for the septic newborn

Answer 5

• ## IVABS 7-10 days

Question 6

Explain sources of infection in a newborn

Answer 6

• mother
• envorment
• equipment

Question 7

Identify common pathofens to which neonates are most succeptible

Answer 7

Early Sepsis:
- TORCH - Toxoplasmosis, other agents, rubella, CMV, Herpes symplex virus
- GBS
- Listeria
- Group A strep

Late Sepsis:
- coag neg staph
- E. Coli
- Candidia

Question 8

What is used to diagnose sepsis

Answer 8

Golden standard - positive blood culture
CRP - elevatedindicates infection
lumbar punctures
Urine collection if UTI is suspected
CXR to distinguish from pneumonia