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NEONATAL SEPSIS

NEONATAL SEPSIS. By Dr. Gacheri Mutua. Definition. Is a blood infection that occurs in an infant younger than 90 days old. Occurs in 1 to 8 per 1000 live births highest incidence in low birth weight and gestation NB: local figures not compiled. Observable higher incidence

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NEONATAL SEPSIS

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  1. NEONATAL SEPSIS By Dr. Gacheri Mutua

  2. Definition • Is a blood infection that occurs in an infant younger than 90 days old. • Occurs in 1 to 8 per 1000 live births highest incidence in low birth weight and gestation • NB: local figures not compiled. Observable higher incidence • Early onset vs. Late onset

  3. Within 48hrs of life • Equal male and female incidence • Due to organisms acquired from birth canal • >80% of cases due to Group B Streptococcus and gram –ve bacteria • Risk factors : PROM >18hrs, fetal distress, maternal UTI, chorioamnionitis, multiple obstetric procedures, preterm birth • After 48hrs of life • Male predominance • Due to organisms acquired around the time of birth or in hospital • >70% due coagulase -ve Staphylococcus and Staph aureus • Risk: prolonged hospitalisation, IV catheters, endotracheal tubes, cross infection by staff/parents, urinary tract malformations EARLY ONSET LATE ONSET

  4. SIGNS AND SYMPTOMS • General: pallor, lethargy, jaundice, fever, hypothermia • Respiratory: tachypnoea, apnoea, grunting, cyanosis • Cardiovascular: tachycardia/bradycardia, poor perfusion, hypotension • Cutaneous: petechiae, bruising, bleeding from puncture sites • GIT: poor feeding, vomiting, abdominal distension, feed intolerance, loose stools • CNS: lethargy, irritability, seizures

  5. investigations • Blood gas derangements- acidosis and lactate accumulation • Elevated C- reactive protein approximately 12hrs after onset of sepsis and returns to normal within 2 to 7 days of successful treatment • Deranged white blood cell count (esp. neutrophils) • Full blood count: platelets • Blood culture, Lumbar puncture, Urine culture • Hypoglycaemia, elevated bilirubin levels • Chest X-ray

  6. management • Septic baby should be managed in the Special Care Nursery where they can be observed closely • General measures: • Thermal care • Incubator nursing • Phototherapy if warranted • Monitoring of oxygen saturation, heart rate and BP • Respiratory: • Support for apnoea, hypoxia, hypercapnoea and respiratory distress

  7. Cardiovascular: • Plasma volume expanders like Normal Saline 10-20mls/kg initially • Ionotropic support if in shock • Correct electrolytes, glucose levels • Correct haematological derangements- blood, platelets, clotting factors- fresh frozen plasma, exchange transfusion • Enteral feeds are withheld in an unstable infant • Hygiene: • Hand washing by staff and parents • Use of sterile equipment and protective equipment • Frequent changing of catheters, IV lines, urine bags • Sterilizing stethoscope between patients

  8. Antibiotic treatment • Early onset: • Benzylpenicillin 60mls/kg 12hrly, if meningitis suspected 120mg/kg/dose 12hrly • Gentamicin 5mg/kg IV 36hrly if >1200g, 48hrly if <1200g • Late onset: • Vancomycin 15mg/kg 18hrly for term babies • Gentamicin 5mg/kg36hrly for term babies <7days, 24hrly if >7days • Flucloxacillin 25mg/kg/dose 12hrly for preterm babies • Definite treatment dictated by organisms grown at blood culture where present or to be guided by bacterial pattern in the unit

  9. PREVENTION • Hand washing by staff and parents • Use of sterile equipment and protective equipment • Frequent changing of catheters, IV lines, urine bags • Sterilizing stethoscope between patients • Minimize contact with the baby

  10. THANK YOU!!

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