Sepsis Flashcards
What antibiotic is not very effective against G neg bacteria in the CNS?
gent
What antibiotic is generally effective against staph pneumonia and community acquired infections?
vanc
What are the incidences of HSV 1 & 2?
HSV1 (20-25%)
HSV2 975-85%)
HSV incidence ranges from 1 in 3-20k
What is the risk of infx during primary HSV genital infx near delivery?
25-60%
What is the risk of infx during reactivation HSV genital infx near delivery?
< 2%
What percentage of babes with neonatal HSV are born to mothers with no h/o HSV?
75%
What increases the risk of neonatal HSV transmission?
1) prematurity
2) PROM ( > 4h)
3) skin laceration
4) scalp electrode
What percentage of neonatal HSV is transmitted through intrauterine infx?
5%
transplacental or ascending
What percentage of neonatal HSV is transmitted through postnatal infx?
10%
What is the incidence of viremia (disseminated dz) in neonatal HSV?
25%
What is the incidence of neuronal spread with CNS dz in neonatal HSV?
30%
What is the clinical presentation of disseminated neonatal HSV?
1) DIC
2) Pneumonia
3) Hepatitis
4) CNS involvement (60-75%)
5) skin lesions (66%)
6) mortality (25%)- up to 85% without ACV
What is the clinical presentation of CNS neonatal HSV?
1) seizures (41%)
2) lethargy
3) irritability
4) poor feeding
5) temperature instability
6) skin lesions (66%)
7) neurologic morbidity (~70%)
What is the incidence of skin, eyes, mouth dz in neonatal HSV?
45%
What is the indicated management of a symptomatic newborn exposed to HSV at delivery?
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
What is the indicated therapy for neonatal HSV?
IV acyclovir (60mg/kg/day)
What is the recommended duration of ACV tx for SEM HSV?
14 days
What is the recommended duration of ACV tx for disseminated/CNS HSV?
21 days
When should CSF PCRs be checked?
for diagnosis and then conclusion of therapy
What is the recommended HSV suppression therapy?
300mg/m2/dose TID x 6 months
ANC should be assessed at 2-4 weeks and then monthly
What is typical for an early onset (< 7dol) sepsis?
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%
What is typical for an late onset (>7-89 dol) sepsis?
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%
What is typical for an late onset (> 89 dol) sepsis?
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%
How does early onset sepsis typically present?
with fulminant multiorgan disease; often pneumonia
