Sepsis

Question 1

What antibiotic is not very effective against G neg bacteria in the CNS?

Answer 1

gent

Question 2

What antibiotic is generally effective against staph pneumonia and community acquired infections?

Answer 2

vanc

Question 3

What are the incidences of HSV 1 & 2?

Answer 3

HSV1 (20-25%)
HSV2 975-85%)
HSV incidence ranges from 1 in 3-20k

Question 4

What is the risk of infx during primary HSV genital infx near delivery?

Answer 4

25-60%

Question 5

What is the risk of infx during reactivation HSV genital infx near delivery?

Answer 5

< 2%

Question 6

What percentage of babes with neonatal HSV are born to mothers with no h/o HSV?

Answer 6

75%

Question 7

What increases the risk of neonatal HSV transmission?

Answer 7

1) prematurity
2) PROM ( > 4h)
3) skin laceration
4) scalp electrode

Question 8

What percentage of neonatal HSV is transmitted through intrauterine infx?

Answer 8

5%

transplacental or ascending

Question 9

What percentage of neonatal HSV is transmitted through postnatal infx?

Answer 9

10%

Question 10

What is the incidence of viremia (disseminated dz) in neonatal HSV?

Answer 10

25%

Question 11

What is the incidence of neuronal spread with CNS dz in neonatal HSV?

Answer 11

30%

Question 12

What is the clinical presentation of disseminated neonatal HSV?

Answer 12

1) DIC
2) Pneumonia
3) Hepatitis
4) CNS involvement (60-75%)
5) skin lesions (66%)
6) mortality (25%)- up to 85% without ACV

Question 13

What is the clinical presentation of CNS neonatal HSV?

Answer 13

1) seizures (41%)
2) lethargy
3) irritability
4) poor feeding
5) temperature instability
6) skin lesions (66%)
7) neurologic morbidity (~70%)

Question 14

What is the incidence of skin, eyes, mouth dz in neonatal HSV?

Answer 14

45%

Question 15

What is the indicated management of a symptomatic newborn exposed to HSV at delivery?

Answer 15

1) culture or PCR of mucosal surfaces and blood
2) lesions for HSV PCR/culture (unroofed vesicles)
3) CSF for HSV PCR and indices
4) CBC with diff and LFT’s (ALT) and BUN/Crt
5) Brain MRI and EEG
6) eye exam, hearing eval

Question 16

What is the indicated therapy for neonatal HSV?

Answer 16

IV acyclovir (60mg/kg/day)

Question 17

What is the recommended duration of ACV tx for SEM HSV?

Answer 17

14 days

Question 18

What is the recommended duration of ACV tx for disseminated/CNS HSV?

Answer 18

21 days

Question 19

When should CSF PCRs be checked?

Answer 19

for diagnosis and then conclusion of therapy

Question 20

What is the recommended HSV suppression therapy?

Answer 20

300mg/m2/dose TID x 6 months

ANC should be assessed at 2-4 weeks and then monthly

Question 21

What is typical for an early onset (< 7dol) sepsis?

Answer 21

1) maternal complications are common
2) prematurity (25%)
3) source of organism is usually genital tract
4) no typical clinical presentation or RDS
5) mortality 5%-15%

Question 22

What is typical for an late onset (>7-89 dol) sepsis?

Answer 22

1) maternal complications are less common
2) prematurity not usually a factor
3) source of organism is usually genital tract or nosocomial or community
4) typical clinical presentation is focal
5) mortality 2%-10%

Question 23

What is typical for an late onset (> 89 dol) sepsis?

Answer 23

1) maternal complications are common
2) birth weight < 1kg
3) source of organism is usually nosocomial or community
4) typical clinical presentation is focal
5) mortality 5%-60%

Question 24

How does early onset sepsis typically present?

Answer 24

with fulminant multiorgan disease; often pneumonia