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Neonatal Infection and Sepsis

Neonates are more prone to infection. This topic is about the Neonatal Infection and Sepsis with their definition, classification, clinical features, major causes of infections, risk factors, prevention treatment etc. feel free to ask any questions in the comment section. You can made power point presentation shortly known as ppt or Save the Page as PDF for future use. It is also known as Sepsis neonatorum or Neonatal septicemia.

Neonatal Infection and Sepsis
Neonatal Infection and Sepsis

Neonatal Sepsis:

Neonatal sepsis is a bacterial infection in the blood in infants during the first month of life OR in an infant younger than 90 days old.

Classification of Neonatal Infections:

Superficial infections:

  • Conjunctivitis
  • Skin sepsis
  • Paronychia
  • Umbilical infection
  • Candida infection
  • Oral thrush
  • Perineal candidiasis

Systemic infections:

  • Neonatal sepsis
  • Meningitis
  • Pneumonia
  • UTI
  • Osteomyelitis/septic arthritis
  • Diarrhoea
  • Neonatal tetanus

Congenital Infections (TORCHS-To Remember):

  • Congenital syphilis
  • Toxoplasmosis
  • Other agents ( Varicella Zoster, HIV, Hepatitis B virus, N gonorrhea, M tuberculosis, Chlamydia trachomatis)
  • Rubella, CMV, Herpes simplex.

Classification of Neonatal Sepsis:

Early onset is caused by an infection transferred from the mother may be from the placenta or birth canal during birth. Late onset sepsis is caused by bacteria from the caregiving environment. According to WikiPedia:

Neonatal sepsis is divided into two categories: Early Onset Sepsis (EOS) and Late Onset Sepsis (LOS). EOS refers to sepsis presenting in the first 7 days of life (although some refer to EOS as within the first 72 hours of life), with LOS referring to presentation of sepsis after 7 days (or 72 hours, depending on the system used).

1. Early onset neonatal sepsis (EONS):

  • Onset: Birth-1 week
  • Usually from maternal genital tract.
  • Agents: GBS, E coli, Listeria
  • Usually present with respiratory distress

2. Late onset neonatal sepsis (LONS):

  • Onset: 8-28 days
  • Usually nosocomial or community acquired
  • Agents: GBS, HBV, E coli, Staphylococcus, candida
  • Present with meningitis

Organisms Responsible for Neonatal Sepsis:

  • Bacteria: Group B streptococci (GBS), E coli, Listeria, Coagulase negative staphylococci, Pseudomonas.
  • Viruses: HSV, Enterovirus, Toxoplasmosis
  • Fungi: Candida
  • Protozoa: Plasmodium, Toxoplasmosis.

Most frequent Signs & Symptoms of Neonatal Sepsis:

Mostly Nonspecific:

  1. Unable to suck.
  2. Fever or Frequent changes in temperature.
  3. Poor cry or Lethargy.
  4. Poor perfusion.
  5. Diarrhea
  6. Reduced movements
  7. A heart rate above 160 can also be an indicator of sepsis, this tachycardia can present up to 24 hours before the onset of other signs.
Respiratory distress Tachypnea (resp. rate. 60/min), grunting, cyanosis, retractions, nasal flaring.
Temperature instability Fever .37.90C, or hypothermia
Poor feeding Vomiting, diarrhoea, abdominal distension.
Altered neurological status Lethargy, irritability, hypotonia, seizures, abnormal reflex.
Apnea especially in preterm infants
Poor perfusion pallor, mottling, capillary refill >3 sec
Hypotension Tachycardia
Bleeding Purpura, Petechiae, bleeding from pric site.
Bulging fontanel meningitis
Others Jaundicehepatosplenomegalysclerema

Painful bone & joints.

Risk factors for Neonatal Sepsis:

Major risk factors:

  • Premature Rupture of membrane (PROM) > 24 hrs
  • Maternal intrapertum fever > 100.40F/ 380C
  • Chorioamnionitis
  • Sustain fetal heart rate >160

Minor risk factors:

  • PROM >12 hrs.
  • Maternal intrapertum fever > 99.50F/37.50C
  • Maternal WBC count >15000/mm3
  • Low Apgar score (<5 at 1 minute, <7 at 5 minute)
  • Low birth weight (<1500g)
  • Preterm labour (37 weeks)
  • Multiple gestation
  • Foul lochia
  • Maternal GBS colonization.

Diagnosis by Investigations:

There are some investigations required to confirm the diagnosis and assist in treatment plan. The following investigations plan can be helpful in a typical case. your doctor will ask about the infant’s symptoms and medical history.

1. Blood Tests such as

  1. DLC (Differential Leukocyte Count)
  2. Micro ESR (Erythrocyte Sedimentation Rate) titer > 55mm
  3. Total Leucocyte count <5000 per cubic mm.
  4. Elevated Haptoglobulin.
  5. Complete blood count (CBC)
  6. Blood culture.

2. CSF Study.

3. Chest Xray.

4. Urine Culture.

5. Gastric aspirate showing > 5 polymorphs per high power field.

Treatment of Neonatal Sepsis:

Urgent treatment is necessary to save the neonate. but it is mostly clinically difficult to diagnose Sepsis. So, if there is even a remote suspicion of sepsis, they are frequently treated with antibiotics empirically. Initial Fluid resuscitation and Supportive care must be done simultaneously. Infant should be hospitalized ASAP. Treatment may last 2-21 days. Sepsis that is confirmed with a culture test is treated for 7-21 days.

Antibiotic regimen in infants with suspected sepsis is a beta-lactam antibiotic (usually ampicillin) in combination with an aminoglycoside (usually gentamicin) or a third-generation cephalosporin (usually cefotaxime). Ceftriaxone is generally avoided in neonates due to the theoretical risk of kernicterus.

Prevention of Neonatal Sepsis:

1. Mother should be under proper antenatal care. If there is any sign of premature leakage then treat with proper antibiotic (broad spectrum).

2. Baby should be born through an aseptic way. After birth, put the baby on a warm sterile cloth on a tray.

3. Keep the baby warm & clean.

4. Less handling of the baby.

5. Hand washing before handling the baby.

6. Early diagnosis of the infections by using different screening method.

7. If mother infected by any infectious disease it should be treated properly. Early treatment of infection with ampicillin, Cloxacillin, or penicillin- gentamycin.

8. After birth, the cord should be cut by a sterile blade & cleaned daily with rectified sprit until it drops it.

9. care of the eye to prevent conjunctivitis. Before the baby to open the eyelids, eye should be cleaned with sterile wet swabs. Silver nitrate solution (1%) or freshly prepared penicillin drops should be installed into eyes.

10.  Baby may acquired infection from birth canal of mother so treat of mother of any infection of birth canal.

Helpful Links and PDF Download:

MedlinePlus Medical Encyclopedia – http://goo.gl/tq4B

Wikipedia, the free encyclopedia – http://goo.gl/QUsrjo

Pediatrics.med.nyu.edu Neonatal Sepsis – http://goo.gl/nSpS39

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis – http://goo.gl/uYj4Xz

PPT Download:

www.peds.umn.edu 3.78 mb

Neonatal Sepsis – Alverno College Faculty  2.45 mb

http://faculty.weber.edu 1.48 mb

www.med.mui.ac.ir 0.99 mb

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