The Ill Newborn/Neonatal Collapse Flashcards
Define Early Onset Infection
Infection <48hrs after birth
What are the causes of early onset infection?
- Bacteria from the birth canal ascending and invading amniotic fluid with secondary infection of the foetus
- Pneumonia and secondary bacteraemia/septicaemia
- Congenital viral infections
- Early onset Listeria monocytogenes infection
List the risk factors for early onset infection
- Prolonged or premature rupture of membranes
2. Maternal fever during labour
How does neonatal infection present?
- Respiratory distress
- Temperature instability
- Poor feeding
- Vomiting
- Apnoea and bradycardia
- Abdominal distension
- Jaundice
- Neutropenia
- Hypoglycaemia/Hyperglycaemia
- Shock
- Irritability
- Seizures
- Lethargy/drowsiness
What investigations would you perform if you suspected neonatal infection?
- CXR
- Septic screen:
- FBC
- Blood cultures
- CRP
How can we manage neonatal infection?
- IV antibiotics ASAP:
- Amoxicillin + CefoTAXime
- Gentamicin for gram negative cover - If confirmed GBS:
- Benzylpenicillin IV + Gentamicin IV - If cultures and CRP negative and no clinical indicators:
- Stop antibiotics after 36-48hrs - Blood culture positive or neurological signs:
- CSF examined and cultured
Define Late Onset Infection
Infection >48hrs after birth
What are the sources of late onset infection?
- Infant’s environment
- NICU:
- Indwelling CVC
- Invasive procedures
- Tracheal tubes
What is the most common pathogen associated with late onset infection?
Coagulase negative staphylococcus - e.g Staph epidermidis
What are the risks of prolonged broad spectrum antibiotic use in preterm infants?
Predisposes to invasive fungal infection
How can we measure the response to therapy in neonatal infection?
Serial CRP measurements
How does neonatal meningitis present?
- Nonspecific signs
- Late signs:
- Bulging fontanelle
- Hyperextension of the neck and back
How is neonatal meningitis treated?
IV Amoxicillin and CefoTAXime and consider gentamicin for gram neg cover
List the complications of neonatal meningitis
- Cerebral abscess
- Ventriculitis
- Hydrocephalus
- Hearing loss
- Neurodevelopmental impairment
When does Group B Streptococcal (GBS) infection present?
Can be early or late onset infection
What are the features of early onset GBS disease?
- Respiratory distress
- Pneumonia
- Mortality with positive blood or CSF cultures up to 10%
How does late onset GBS disease present?
- Meningitis
- Focal infection (occasionally)
- Can be developed up to 3mths of age
What are the risk factors for developing GBS infection?
- Preterm
- Prolonged rupture of membranes
- Maternal fever during labour (>38)
- Maternal chorioamnionitis
- Previously infected infant
How can GBS infection be prevented?
Intrapartum antibiotic prophylaxis given to those at risk
How is Listeria monocytogenes infection transmitted to the mother?
Transmitted in food:
- Unpasteurised milk
- Soft cheeses
- Undercooked poultry
How does Listeria infection present in the mother and transmit to the foetus?
Presents as mild bacteremia and mild flu-like illness in the mother
Transmits to foetus across placenta
List the consequences of maternal infection with Listeria
- Spontaneous abortion
- Preterm delivery
- Fetal/neonatal sepsis
What are the characteristic features of Listeria infection?
- Meconium stained liquor
- Widespread rash
- Septicaemia
- Pneumonia
- Meningitis
What is the mortality rate with Listeria infection?
30%
What are the common causes of neonatal conjunctivitis?
- Staphylococcal and Streptococcal organisms
- Gonococcal infection
- Chlamydia trachomatis infection
What are the features of Staph/Strep conjunctivitis and how is it managed?
Features: - Discharge - Redness of the eye Management: - Clean with saline or water - Topical antibiotic eye ointment (Chloramphenicol or Neomycin)
What are the features of gonococcal conjunctivitis and how is it managed?
Features:
- Purulent discharge (gram stained and cultured URGENTLY)
- Swelling of eyelids (<48hrs after birth)
Management:
- Clean with saline or water
- Immediate 3rd generation cephalosporin IV or penicillin
- Cleanse eye frequently
May lead to permanent loss of vision
What are the features of Chlamydia conjunctivitis and how is it managed?
Features:
- Purulent discharge (immunofluorescent staining)
- Swelling of eyelids (1-2wks after birth)
Management:
- Clean with saline or water
- Erythromycin PO for 2wks
- Mother and partner checked and treated
List the risk factors for Herpes Simplex Virus infection in neonates
- Infant born to mother with primary genital infection
- Recurrent maternal infection
- More common in preterm infants
How does HSV infection in neonates present?
- Any time up to 4wks after delivery
- Localised herpetic lesions on skin or eye
- Encephalitis
- Disseminated disease (HIGH MORTALITY)
How can we prevent neonatal HSV infection?
Mother with primary genital infection: - Elective C-Section Mother with hx of recurrent genital infections: - Deliver vaginally - Maternal treatment before delivery
How can we prevent vertical transmission of Hepatitis B infection?
Give the Hepatitis B vaccine shortly after birth
Complete course of vaccinations during infancy
Check antibody response
What are The Sepsis Six?
GIVE THREE: 1. Oxygen 2. Antibiotics 3. Fluids TAKE THREE: 1. Blood cultures 2. Urine output 3. Lactate
List the most common causes of neonatal meningitis/sepsis?
Group B Strep
Eschericia coli
Listeria moncytogenes
What features will be present in the history of a neonate with sepsis?
- Fever
- Poor feeding
- Miserable, irritable, lethargy
- History of focal infection
- Predisposing conditions
List the features that may be present on examination of a neonate with sepsis
- Fever
- Tachycardia, tachypnoea, low BP
- Purpuric rash
- Shock
- Multi-organ failure
What are the management priorities in a neonate with sepsis?
- ANTIBIOTICS without delay
- FLUIDS and monitoring of fluid balance
- CIRCULATORY SUPPORT - usually inotropic
- Beware of DIC - treat clotting derangement with FFP, cryoprecipitate and platelet transfusions
