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 gestationNB: local figures not compiled. Observable

higher incidence Early onset vs. Late onset

EARLY ONSET LATE ONSET

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

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

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

MANAGEMENT Septic baby should be managed in the

Special Care Nursery where they can be observed closely

General measures:Thermal care Incubator nursingPhototherapy if warrantedMonitoring of oxygen saturation, heart rate

and BP Respiratory:

Support for apnoea, hypoxia, hypercapnoea and respiratory distress

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

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

PREVENTIONHand washing by staff and parentsUse of sterile equipment and

protective equipmentFrequent changing of catheters, IV

lines, urine bagsSterilizing stethoscope between

patientsMinimize contact with the baby

THANK YOU!!