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Neonatal Sepsis

Neonatal Sepsis. Armanian Amir Mohammad , MD Neonatologist Assistant Professor of Isfahan Faculty of Medicine. Sepsis neonatorum is the term used to describe any systemic bacterial infection documented by a P ositive blood culture in the first month of life. SYMPTOMS AND SIGNS.

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Neonatal Sepsis

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  1. Neonatal Sepsis ArmanianAmir Mohammad , MD Neonatologist Assistant Professor of Isfahan Faculty of Medicine

  2. Sepsis neonatorum is the term used to describe any systemic bacterial infection documented by a Positive blood culture in the first month of life.

  3. SYMPTOMS AND SIGNS • The signs and symptoms of neonatal sepsis often are nonspecific

  4. CLINICAL MANIFESTATIONS • level of Activity

  5. CLINICAL MANIFESTATIONS • Pattern of Feeding Abdominal distention / lavage / …

  6. CLINICAL MANIFESTATIONS • muscle Tone

  7. CLINICAL MANIFESTATIONS • level of Alertness

  8. CLINICAL MANIFESTATIONS respiratory status or effort (Breathing)

  9. CLINICAL MANIFESTATIONS • Peripheral Perfusion

  10. CLINICAL MANIFESTATIONS • level of Activity • Pattern of Feeding • muscle Tone • level of Alertness • respiratory status or effort (Breathing) • Peripheral Perfusion • The negative predictive value (NPV) of this scoring system was 96%

  11. Thus, although observational findings alone cannot replace the physical examination and laboratory studies, they are an important aspect of the evaluation.

  12. Temperature elevation in full-term infants is uncommon. • Temperature elevation is infrequently associated with systemic infection when only a single elevated temperature occurs.   • Temperature elevation that is sustained longer than an hour is frequently associatd with infection.   • Temperature elevation without other signs of infection is infrequent

  13. Early-onset disease • GBS, E. coli and other gram-negative enteric bacilli, and L. monocytogenes: ampicillin + an aminoglycoside(gentamicin) Multidrug-resistant bacteria: tobramycin and amikacin. (Ampi + Amika ) If meningitis is suspected: cefotaxime, for better CNS penetration. (Ampi + Amika + Cefo ) ampicillin - gentamicin)

  14. late-onset disease ( community acquired) • Empirical therapy for late-onset disease acquired in the community should provide coverage for the same neonatal pathogens of early onset and for potential community acquired pathogens, such as S. pneumoniae ,N.meningitidis & H.influenza. Because meningitis frequently is a component oflate-onset sepsis, antibiotics with good CNS penetration should be selected. Ampicillinand a third-generation cephalosporin (e.g., cefotaxime) are commonl recommended. (Ampi + cefo ) Ampicillin - Cefotaxime

  15. late-onset disease (nosocomial acquired) • CONS, enterococci, gram-negative enteric bacilli (including drug-resistant strains), and fungi: • Vancomycin generally is active against all staphylococcal species, streptococci, and mostenterococci. • Vancomycin and gentamicin are commonly used for initial therapy: (Vanco + genta or Amika ) • when gram-negative meningitis is a concern: (Vanco + Cefo ) Cefotaxime does not have activity against Pseudomonas, enterococci ,L. monocytogenes. : PEL Ceftazidime(Vanco + Cefta ) Vancomycin-Cefotaxime

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