Sepsis Flashcards
What is classified as early onset sepsis?
Less than 48 hours after birth
What causes early onset sepsis?
When bacteria has ascended the birth canal and invaded the amniotic fluid. The fetus is infected because the fetal lungs are in direct contact with infected amniotic fluid
- these infants have pneumonia and secondary sepsis
What increases the risk of early onset sepsis?
If there has been prolonged or premature rupture of the amniotic membranes
If chorioamniotis is clinically evident e.g fever during labour
How does early onset infection present?
Respiratory distress Temperature instability Other clinical features e.g: Poor feeding Vomiting Apnoea or bradycardia Abdominal distension Jaundice Neutropenia Hypo/hyperglycaemia Shock Irritability Seizures Lethargy, drowsiness
In meningitis: tense or bulging fontanelle, head retraction
What investigations are done for early onset sepsis?
CXR Blood cultures Blood gas - glucose and lactate FBC - to detect neutropenia CRP helpful but takes 12-24 hours to rise, so one normal result does not exclude infection, 2 consecutive normal values are strong evidence against infection U&E and coagulation Potentially LP
What antibiotics are given for early onset sepsis?
Gentamicin - cover for gram neg organisms
Amoxicillin
Cefotaxime
What is classified as late onset sepsis?
> 48 hours after birth
In late onset neonatal sepsis, what is often the source?
The infant’s environment
In late onset, is the presentation usually non specific?
Yes
What are the main sources of infection for late onset sepsis in intensive care?
Indwelling central venous catheters for parenteral nutrition
Invasive procedures that break skin barrier
Tracheal tubes
What is the most common pathogen in late onset sepsis?
Coagulate negative staphylococcus- staphylococcus epidermis
But the range of organisms is broad and includes gram positive and negative bacteria
What is early onset sepsis primarily caused by?
GBS
What risk factors are there for neonatal sepsis?
Mother who has had previous baby with GBS
Mother has current GBS colonisation from prenatal screening
Current bacteruria
Intrapartum temp > 38
Membrane rupture > 18 hours
Prematurity - approx 85% neonatal sepsis cases are in premature neonates
Low birth weight
Evidence of maternal chorioamnionitis
What signs suggests respiratory distress?
Grunting Nasal flaring Accessory muscle usage Tachypnoea Subcostal and intercostal recession
Are term infants more likely to be febrile?
Yes
