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Pediatrics > Spesis/meningitis > Flashcards

Spesis/meningitis Flashcards

1
Q

What are the clinical features of sepsis?

A 
Temperature instability
Irritability
Poor feeding
V/D
Respiratory distress
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2
Q

What is respiratory distress?

A

Tachypnea
Grunting
Nasal flaring
Retractions

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3
Q

What are neonatal RFs for spesis?

A 
Male
Premature
Low birth wt
Resuscitation required
Infected sibling
AA
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4
Q

What are maternal RFs for sepsis?

A 
GBS +
GBS bacteriuria during pregnancy
Membrane rupture (>/= 18 h)
Intrapartum temp (>/=38C)
Chorioamnionitis
Multiple gestations
Previous infant w/GBS invasive dz
= 20 yo
Intrauterine monitoring
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5
Q

What do we use to evaluate if a neonate has sepsis?

A 
CBC w/diff
CRP
Cultures 
- Micro: blood, CSF, urine
- Virology: CSF, surface samples
Chest xray
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6
Q

What is chorioamnionitis?

A

Maternal fever PLUS 2 below:

  • Fetal tachycardia (HR >/= 160)
  • Foul odorous amniotic fluid
  • Maternal leukocytosis (WBC >/= 15,000)
  • Maternal tachycardia (HR >/= 100)
  • Uterine tenderness
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7
Q

What are the risk factors for sepsis at <37 week gestation?

A

Chorioamnionitis
Premature rupture of membranes (PROM)
Intrapartum antimicrobial prophylaxis (IAP)

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8
Q

What are the RFs for sepsis at >/=37 week gestations?

A

Chorioamnionitis

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9
Q

What do we do if the neonates are at <37 weeks gestation/ >/= 37 weeks gestation with corresponding RFs?

A

Birth: blood culture
6-12h old: CBC w/diff +/- CRP
All: broad spectrum abx

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10
Q

What do we do if a neonate has suspected sepsis and the culture comes back positive?

A

Continue abx

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11
Q

What do we do if the culture is negative and the neonate remains well?

A

Check the labs
Normal labs = dc abx
Abnormal labs = continue abx

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12
Q

What does an abnormal blood lab look like?

A 
ANC < 1.75
CRP > 1
I:T > 0.2
Plt < 100,000
WBC < 5
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13
Q

What does an abnormal CSF look like?

A

Glucose < 10
Preterm protein > 250
Term protein > 100
WBC > 25

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14
Q

What are the neonatal sepsis classifications?

A 
Early onset (EOS)
Late onset (LOS)
Congenital
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15
Q

What is EOS?

A

= 3 DOL

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16
Q

How is EOS transferred?

A

Perinatal transmission

Vertical transmission

17
Q

What is LOS?

A

> 3 DOL

18
Q

How is LOS transferred?

A

Community aquired
Nosocomial
Vertical transmission

19
Q

What is congenital sepsis?

A

<10-14 DOL

20
Q

How is congenital sepsis transferred?

A

Transplacental transmission

21
Q

What are the common pathogens of EOS?

A

GBS
E. coli
(less common: listeria)

22
Q

What are the common pathogens of LOS?

A

CONS

S aureus

23
Q

What are the common pathogens for congenital sepsis?

A 
Toxoplasma
Trepenema
Rubella
CMV
HSV
VZV
24
Q

What is the treatment of empiric EOS?

A

Amp + AG/cefotaxime

25
Q

What is the treatment for GBS/Listeria?

A

Amp/Pen + AG

26
Q

What is the treatment for E coli?

A

Cefotaxime/AG/meropenem

27
Q

What is the treatment for enterococcus?

A

Amp/Vanc + AG

28
Q 
What is the duration of therapy for:
Empiric EOS
GBS/Listeria
E coli
Enterococcus
A 
7 days (presumed sepsis)
10 days (sepsis)
14 days (GBS sepsis)
21 days (GNR/listeria meningitis)
29
Q

What is the treatment for HSV?

A

Acyclovir
14 (mouth, eye skin)
21 (disseminated, CNS)

30
Q

What is the treatment for empiric LOS?

A

Vanc + AG

31
Q

What is the treatment for pseudomonas?

A

Pip/tazo or antipseudomonal ceph/carbapenem
+
AG

32
Q

What is the duration of treatment for:
Empiric LOS
Pseudomonas

A

Presumed sepsis = 7 days
Sepsis = 10 days
GBS meningitis = 14 days
GNR meningitis = 21

33
Q

What is the treatment for CONS/staph?

A

Vanc/oxacillin x 14 days

34
Q

What is the treatment of candida?

A

Amphotericin B x 21 days

35
Q

What is dosing for Amp?

A

50-100 mg/kg/dose

36
Q

What is dosing for cefotaxime?

A

same as Amp

37
Q

What is dosing for acyclovir?

A

10-20 mg/kg/dose

38
Q

What is peak and trough levels for gent?

A

Peak: 6-12 mcg/mL
Trough: <1-2 mcg/mL

39
Q

What is dosing for PCN?

A

50,000 - 100,000 units/kg

Pediatrics (9 decks)

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