Sepsis **** Flashcards
What type of baby is this more common in?
Premature babies
How is it acquired?
Transplacentally via ascent from vagina
Environment
What is it classed as?
Early onset (within 48 hours) Late onset
Presentation
Non-specific and subtle Labile temperature Lethargy Poor feeding Respiratory distress Collapse
Management:
Bedside
Bloods
Imaging
ABC
Supportive
Lumbar puncture for culture, glucose, protein count, WCV and gram stain
Swabs if not responding
FBC, CRP, glucose
CXR
ABCDE - Assessment and Management - AIRWAYS
Assess:
are they talking or crying?
is there stridor?
M: High flow oxygen suction or airway adjuncts NEB/IM adrenaline or steroids Intubation is the definitive management
ABCDE - Assessment and Management - BREATHING
Respiratory distress? Chest expansion Breath sounds Oxygen SATS Signs of distress - pallor, cyanosis, agitation or drowsinesss ------- High flow oxygen Inhaled salbutamol or ipratropium Steroids IV/PO Salbutamol, MgSO4 or aminphylline IV Consider CXR, ABG and PICU transfer
ABCDE - Assessment and Management - CIRCULATION
HR and pulse volume Central cap refill Core-periphery temperature gap BP: Hypotension is a late sign as kids can maintain this until the very late stage Urine output: wet nappies? --- Fluids pr blood products in trauma If IV fluids needed but access difficult, go for intra-osseous
ABCDE - Assessment and Management - Disability
AVPU/GCS if <8, need an airway adjunct or intubation Pupils Tone BM Temperature
ABCDE - Assessment and Management - Exposure
Rashes especially purpura
Urticaria if anaphylaxis
Antibiotics given in early-onset - 2
How long?
What if meningitis is suspected? How long?
What if listeria is suspected?
Broad spectrum AB’s - benzylpenicillin + gentamicin until blood culture returns
7 days if cultures positive
Give cefotaxime - if confirmed, continue for 14-21 days
Give ampicillin/amoxicillin
Antibiotics given in late-onset - 2
What if meningitis is suspected?
Broad-spectrum antibiotics e.g. flucloxacillin + gentamacin
Give cefotaxime
Risk Factors for early-onset
Prolonged rupture of membranes > 18hrs Maternal infections: maternal pyrexia, chorioamnionitis, UTI Mother carrier of Group B strep Preterm labour Fetal distress Breaks in neonatal skin / mucosa
Risk Factors for late-onset
Central lines and catheters Congenital malformation e.g. spina bifida Severe illness Malnutrition Immunodeficiency
