GDS. K.13a. Neonatal Sepsis

8/2/2019 GDS. K.13a. Neonatal Sepsis

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Direct Causes of Neonatal DeathsWorld Health Organization. State of the Worlds Newborns 2001

Infections 32%

Asphyxia 29% Complications of prematurity 24%

Congenital anomalies 10%

Other 5%


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Definition

Neonatal sepsis is a clinical syndrome

Of systemic illness accompanied by

bacteremia occurring in the first monthof life


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Early Onset

< 72 hours of ageAcquired around birth

Vertical transmission

from mother to baby

Late Onset

> 72 hours of ageAcquired from the

environment

Nosocomial or

hospital acquired

Distinction between Early onset sepsis and Late onset sepsisnot clear in developing countries:

baby born at home and brought to the hospital at 3 days of age baby referred from another hospital


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Early Onset Sepsis - risk factors

Prolonged rupture of

membranes >18 h

Maternal chorioamnionitis

Foul smelling amniotic fluid

Handling by untrained midwife

Maternal urinary tract infection

Premature labor


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Late Onset Sepsis -

risk factors

Prematurity/ LBW

In hospital

Invasive procedures- ventilator, IV lines,central lines, urine catheter, chest tube

Contact with infectious disease - doctors,

nurses, babies with infections,

Not fed maternal breast milk

POOR HYGIENE in NICU


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Bacterial Pathogens Responsible for Sepsis

in Developing Countries

Early onset sepsis

Gram negative

bacilliE.coli Klebsiella

Enterococcus

Group B

streptococcus

Late onset sepsis

Gram negative

bacilliPseudomonasKlebsiella

Staph aureus

Coagulase negative

staphylococci


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Diagnosis of Neonatal Sepsis

Clinical signs and symptoms

Laboratory tests

culture of bacterial pathogen

other laboratory indicators


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Diagnosis of Neonatal Sepsis -clinical signs and symptoms

Clinical Signs: early signs non- specific, may besubtleRespiratory distress- 90%ApneaTemperature instability- temp more commonDecreased activity IrritabilityPoor feedingAbdominal distensionHypotension, shock, purpura, seizures-late

signs


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Purpura


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Pseudomonas sepsis with DIC


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Laboratory Tests

Cultures to identify bacterial pathogenblood, csf, urine, other

Hematological testsWBC count

Platelet count

Erythrocyte Sedimentation Rate (ESR)

Other testsC- reactive protein


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Abnormal white blood cell count

Total WBC count < 5000 /L, > 25, 000/L

Absolute neutrophil count: 0.2 Immature to mature neutrophil ratio > 0.2

bandform

neutrophil


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Chest X Ray

Group B streptococcal sepsis:

diffuse ground glass opacity indistinguishablefrom HMD

Persistent focal parenchymal lung findings


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Group B Strep

Pneumonia


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First line therapy in facility setting(WHO 2003)

Ampicillin 50 mg/ kgevery 12 hours in 1st week of life

every 8 hours from 2- 4 weeksPLUSGentamicin> usia kehamilan 35 minggu: 4 mg / kg setiap

24 jamusia kehamilan 30 - 34 minggu:

0 - 7 hari: 4.5 mg/kg setiap 36 jam

> 8 hari: 4 mg/kg setiap 24 jam


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Suspected Staphylococcal Infection

Use Cloxacillin or flucloxacillin instead ofAmpicillin.

Plus gentamicin


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Baby not responding to first line antibiotics

or suspected hospital acquired infection

3rd generation cephalosporin

cefotaxime

ceftazidime

For nosocomial infection :

vancomycin plus gentamicin/

amikacin or ceftazidime


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Treatment of Fungal Infection

Amphotericin B

Intravenous infusionfor 14 to 21 days


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Duration of antibiotic treatmentSepticemia

Gram negative septicemia: 14 days

Group B Strep septicemia: 10-14 days

Repeat blood culture within 24 - 48 hours of

beginning treatment to document clearance of

organism.


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Duration of antibiotic treatment

Meningitis

Gram negative meningitis: 21 days minimum

Group B Strep meningitis: 14 - 21 days

Document negative culture within 24 - 48 hours

of beginning treatment

Consider neuroimaging studies


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Supportive Care

Temperature support

GI support - vomiting, ileus

Cardiorespiratory support hypoxia, apnea, shock

Hematological support: anemia,

thrombocytopenia, DICNeurological support- seizures


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Prevention of Nosocomial Infection

Hand washing

Early feeding

Maternal breast milk

Decrease use of broad spectrum antibiotics

Decreased use of invasive procedures

Proper sterilization procedures


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Prevention of Sepsis


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GDS. K.13a. Neonatal Sepsis

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