Sepsis and Seizures Flashcards
Where does an infection that can causes sepsis come form in neonates?
Infection can occur trans placentally, via ascent from vagina, during birth or from the environment.
What features would suggest that a neonate might have sepsis?
Labile temperature Lethargy Poor feeding Respiratory distress Collapse DIC Listeria – purulent conjunctivitis or maternal infection
What are the risk factors for early onset sepsis?
Premature vs term increased risk Prolonged PROM Maternal infection – intrapartum pyrexia or chorioamnionitis Mother GBS carrier Foetal distress Breaks in skin or mucosa
What organisms usually causes early onset sepsis?
Usually GBS, E. coli or listeria. Can also be Herpes (if primary infection within 6 week prior to delivery), Chlamydia, anaerobes and H Influenza.
What are the risk factors for late onset sepsis?
Central lines and catheters Congenital malformations Severe illness Malnutrition Immunodeficiency
What organisms usually causes late onset sepsis?
Tends to be due to environmental organisms such as coagulase negative Staph, S. Aureus, E. coli and GBS. Candida should be considered if failure to responds.
How should a neonate with suspected sepsis be investigated?
FBC, CRP, and glucose
Blood cultures
CXR
Lumbar puncture for culture, gram stain, protein count, WCC and glucose.
If failure to respond then: throat swab, stool sample, virology and urine CMV culture
How should a neonate with suspected sepsis be managed?
ABC
High flow oxygen
Supportive treatment e.g. ventilation and fluid
Early inotropes
Which antibiotics should be used in early onset sepsis in a neonate?
Broad spec benzylpenicillin and gentamicin until blood cultures return. Continue for 7 days if cultures are positive otherwise stop.
If meningitis is suspected, then give cefotaxime and treat for 14-21 days if confirmed.
If Listeria is suspected, then give ampicillin/amoxicillin.
Which antibiotics should be used in late onset sepsis in a neonate?
Broad spec flucloxacillin and gentamicin
If meningitis is suspected, then give cefotaxime
Coagulase negative likely in preterm with CVP line so give vancomycin and consider removal
Consider fungal sepsis if failure to respond
When do seizures in neoates most often occur?
Usually occurs 12-48 hours after birth and can be generalised, focal, tonic, clonic or myoclonic.
What features do neonates have when suffering from a seizure?
Sign of seizure can be subtle Lip-smacking Eye deviation Apnoea’s EEG can confirm the diagnosis
What causes seizures in a neonate?
Hypoxic ischaemic encephalopathy
Infection (meningitis/encephalitis)
Shock – twin twin transfusion, blood loss, sepsis, cardiac abnormality and fluid loss
Intracranial haemorrhage/infarction
Structural CNS lesions e.g. focal cortical dysplasia (mal migration of neurons) or tuberous sclerosis (multiple benign growths)
Metabolic disturbance and disorders (Ca, Na and Mg)
Neonatal withdrawal (from maternal drugs)
Kernicterus – bilirubin poisoning
Idiopathic seizures e.g. benign 5th days fits
How should seizures in a neonate be investigated?
Rule out reversible causes such as hypoglycaemia
Get IV access and take bloods – FBC, LFT, Us and Es including Mg, glucose and ABG/VBG
Radiographic investigation – US or MRI of head
Toxicology screening
How are seizures managed in a neonate?
ABCDE and get help
Secure airway and give oxygen
Secure IV access
Check BP, pulse, glucose, Ca and Mg
Start a clock
Check temperature, if raised give rectal paracetamol
After 5 minutes if seizures continue give lorazepam IV or buccal midazolam
After 15 mins of seizures continue repeat dose of lorazepam or midazolam, prep phenytoin
After 20 mins give phenytoin (or phenobarbital if on regular phenytoin) then call anaesthetist and prep for intubation
After 40 mins rapid sequence induction of anaesthesia using thiopental sodium –> PICU
