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Neonatology: Neonatal Septicemia

Neonatology: Neonatal Septicemia. Lecture points. Morbidity and mortality The compromised host of the neonates in immunology Pathogens for clinical consideration Clinical manifestation Clinical Management. Incidence. 1% ～ 10%, in live birth 15-20%, in VLBW. ‰. ‰. Incidence.

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Neonatology: Neonatal Septicemia

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  1. Neonatology:Neonatal Septicemia

  2. Lecture points • Morbidity and mortality • The compromised host of the • neonates in immunology • Pathogens for clinical consideration • Clinical manifestation • Clinical Management

  3. Incidence • 1%～10%, in live birth • 15-20%, in VLBW

  4. ‰ ‰ Incidence Comparison: US and developing countries Gross incidence

  5. Neonatal Septicemia Death rate: US

  6. death rate: 9.8%~12% LONS 7.5% Neonatal Septicemia Death rate：developing countries

  7. Immunological features in neonates • Immature development in body defense • Imperfect function • Less experience of exposure to environment and pathogens • Affected by maternal antibodies

  8. Immunological features in Neonates Non-specific Immune: • Poor barriers function • Undeveloped complement activation capacity • Relative fewer neutrophil, Immature Function • Lower ILs, lower level of cytokines

  9. Immunological features in Neonates Specific Immune: • Quantities and quality of Ig G, A, M • T, B cell: quantities, quality and their function

  10. Pathogens • Domestic: • Staphylococcus: most commonly seen • Escherichia coli, etc. • G- bacillus • US: • GBS: the leading pathogen during 1970’s • Escherichia coli: the leading pathogen during 1990’s

  11. Pathogenic Changes EONS: Changes by G+ vs. G- ‰ Early 1990’s Late 1990’s

  12. Pathogenic Changes

  13. Relevant factors of pathogenic changes • Change of colonized pathogens in maternal birth canal • GBS Screening • Preventive antibiotic therapy used during pre partum • Ampicilline for the mother with GBS positive : • pre partum and Intro-partum GBS Septicemia • Efficacy：around 70%（vs. control P < 0.0001）

  14. EONS： E. coli Listeria monocytogenes, Pseudomonas Meningococcus Enterococcus and GBS LONS： Coagulase-negative Staphylococcus Haemophilus influenza bacillus Other pathogens Pathogens based on the types in developed country

  15. Pathogens based on the typesin developed country

  16. Pathogens based on the types in developing country • VEONS (within 24 hours after birth) • Klebsiella、E. coli、Enterococcus • EONS (within 24-48 hours after birth) G+ = G- G+：mainly Klebsiella pneumoniae and E. coli G-：Enterococcus commonly seen • LONS (48 hours after birth) • Mainly: G+ Coagulase-negative Staphylococcus • Partly reported：Staphylococcus epidermidis, GBS • and E. coli

  17. Pathogens based on the types in developing country Early onset dominant Related with the maternal and the intro-partum high risk factors

  18. Pathogens isolated in China main isolatesfrom blood culture bsed on the ages: n=671/458/1849 临床儿科杂志：2002-2浙江大学附属儿童医院资料

  19. Pathogens isolated in China Domestic data：main isolates: n=815 中华儿科杂志01-6；重庆儿科医院资料

  20. main isolates account for during different periods: n=436 Pathogens isolated in China 临床儿科杂志02-5：深圳市人民医院儿科资料

  21. Pathogens isolated in China main isolates account for during different periods: n=436 临床儿科杂志02-5：深圳市人民医院儿科资料

  22. Pathogens isolated in China main isolates account for during different periods: n=606/475 临床儿科杂志：2002-2 哈尔滨儿童医院资料

  23. The path of Infection • Path: • Intrauterine infection • Intro-partum infection • Post delivering infection

  24. Risk factors of sepsis occurrence • Maternal intro-partum fever (OR=4.1 CI=1.2-13.4) • Repeated Vaginal examinations (OR=2.9 CI=1.1-8.0) • Among GBS Sepsis,Dystocia and maternal fever account for 49% • Prolonged membrane rupture ≥18 hour（79%） • Prematures and LBW • Later onset sepsis: PDA, Long time of Intravascular catheter, various of invasive procedure, BPD

  25. General： Anorexia Less Crying Fewer physical activities Lower temperature or fever Poor weighting gain Persistent Jaundice Focal: Omphalitis Skin infection Blepharitis (eyes) Otitis media Paronychia (nails) Clinical manifestations

  26. Toxic: Shock Hepatosplenomegaly Skin deposition point Distension Anemia Complication: Meningitis Pneumonia Peritonitis Urinary Tract Infection Scleredema DIC Toxic myocarditis Clinical manifestations

  27. Laboratories and investigation aids • Peripheral whole blood test • Blood culture • Others: • CRP/ PCT • Smear of WBC: check bacterial • CSF • Urine • CXR

  28. ClinicalManagement Antibiotic therapy • Selection based on the pathogen isolated • Early,Adequate dose, IV • Duration: • 2 weeks for G+, 3 weeks for G-. • Longer duration for meningitis and severe

  29. Clinical Management Supportive therapy • Dehydration • Correct metabolic acidosis • Maintenance of electrolyte and Acid-base balance • Enough energy supply • Keep warm • Correct hypoxemia • Immunological therapy: IVIG

  30. Clinical Management Complication treatment • Shock • DIC • Scleredema • Respiratory failure • Conversion • Jaundice • Focal lesion

  31. Thanks for listening Questions please?

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