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Is this baby eligible for INIS?

Is this baby eligible for INIS?. 23 weeks gestation, birth weight 475g Day 3 - reduced activity on ventilator, looks seriously ill Screening bloods - CRP 45mg/l,platelets 88 Antibiotics commenced Confirmation of infection day 2 with GBS on blood culture. .

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Is this baby eligible for INIS?

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  1. Is this baby eligible for INIS?

  2. 23 weeks gestation, birth weight 475g • Day 3 - reduced activity on ventilator, looks seriously ill • Screening bloods - CRP 45mg/l,platelets 88 • Antibiotics commenced • Confirmation of infection day 2 with GBS on blood culture

  3. • 23 weeks gestation, birth weight 475g • Day 3 - reduced activity on ventilator, looks seriously ill • Screening bloods - CRP 45mg/l,platelets 88 • Antibiotics commenced • Confirmation of infection day 2 with GBS on blood culture

  4. 26 weeks gestation, birth weight 950g • Day 4, deterioration on ventilator • Increasing oxygen requirement to 80% • Appears unwell • ETS recently grown coagulase negative staphylococci and CXR consistent with pneumonia • Antibiotics commenced

  5. • 26 weeks gestation, birth weight 950g • Day 4, deterioration on ventilator • Increasing oxygen requirement to 80% • Appears unwell • ETS recently grown coagulase negative staphylococci and CXR consistent with pneumonia • Antibiotics commenced

  6. 27 weeks gestation, 1.3kg • PROM 27 hrs • GBS on maternal HVS • Intrapartum antibiotics not given • Asymptomatic infant • Antibiotics commenced as hospital policy

  7. • 27 weeks gestation, 1.3kg • PROM 27 hrs • GBS on maternal HVS • Intrapartum antibiotics not given • Asymptomatic infant • Antibiotics commenced as hospital policy

  8. 27 weeks gestation, birth weight 1360g • Day 38 intermittent bradycardias, then apnoeas resulting in ventilation • Distended, tender abdomen noted with bilious aspirates • Serial AXRs confirm fixed, oedematous bowel loops • NEC diagnosed and antibiotics commenced

  9. • 27 weeks gestation, birth weight 1360g • Day 38 intermittent bradycardias, then apnoeas resulting in ventilation • Distended, tender abdomen noted with bilious aspirates • Serial AXRs confirm fixed, oedematous bowel loops • NEC diagnosed and antibiotics commenced

  10. Term infant • Cyanotic episodes at 2hrs age • Increasing oxygen requirement • CXR patchy consolidation both lung fields • Commenced on antibiotics • CRP 19

  11. • Term infant • Cyanotic episodes at 2hrs age • Increasing oxygen requirement • CXR patchy consolidation both lung fields • Commenced on antibiotics • CRP 19

  12. But • If there was offensive liquor, raised inflammatory markers or this baby was to become unwell This baby would be eligible for INIS

  13. Deterioration day 34 • Recurrent apnoeic episodes • Prolonged cap. refill time • CRP 66 • Commenced on antibiotics • 29 weeks gestation • Positive blood culture

  14. • Deterioration day 34 • Recurrent apnoeic episodes • Prolonged cap. refill time • CRP 66 • Commenced on antibiotics • 29 weeks gestation • Positive blood culture

  15. Remember • It is NOT TOO LATE to randomise an infant after a positive blood culture has been reported • IVIG may be of benefit after the inflammatory process has begun

  16. Every baby counts • Consider all babies to be eligible for INIS • Make sure everyone knows you are the INIS nurse • Make sure they know you do not have to be there for them to recruit a baby into INIS • Remember an ANNP can get consent • Doctors need to write up the prescription

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