R Dhaker, Lecturer, PCNMS 1

Neonatal Sepsis

R Dhaker, Lecturer, PCNMS 2

Introduction • Neonatal Sepsis or sepsis neonatrum occurs

when pathogenic bacteria gain access into the blood stream.

• They may cause overwhelming infection or localize into lungs causing pneumonia or into meaning causing meningitis.

• Neonatal Septicemia occurs in infants less than 90 days of age.

R Dhaker, Lecturer, PCNMS 3

Etiology • A number of different bacteria including E. coli,

listeria and certain strains of streptococcus may

cause neonatal sepsis.

• Early onset neonatal sepsis most often appears

within 24 hours of birth.

R Dhaker, Lecturer, PCNMS 4

Cont… Etiology

• The following increase an infant’s risk of early onset sepsis:- – Group B streptococcus infection during pregnancy – Preterm delivery and LBW baby – Infection of placental tissue and amniotic fluid –Multiple pervaginal examination –Maternal fever and infection

• Babies with late neonatal sepsis get infected after delivery by the organism thriving in the external environment of the home or hospital.

R Dhaker, Lecturer, PCNMS 5

• The following increase infant’s risk of

developing late onset septicemia.

– Having an intracath in blood vessel for long time.

– Hospital stay for long time.

– Lack of aseptic technique following by care givers.

– Lack of breast feeding.

– LBW

– Superficial infection ( pyoderma, umbilical sepsis)

Cont… Etiology

R Dhaker, Lecturer, PCNMS 6

• Organisms that have been implicated in causing late-onset sepsis include the following: – Coagulase-negative Staphylococcus – Staphylococcus aureus– E coli – Klebsiella – Pseudomonas– Enterobacter – Candida – GBS – Serratia – Acinetobacter – Anaerobes

R Dhaker, Lecturer, PCNMS 7

Risk factors• generally well-appearing • previously healthy – full term (at ≥37 weeks gestation)– no antibiotics perinatally– no unexplained hyperbilirubinemia that required treatment– no antibiotics since discharge– no hospitalizations– no chronic illness– discharged at the same time or before the mother

• no evidence of skin, soft tissue, bone, joint, or ear infection

R Dhaker, Lecturer, PCNMS 8

Clinical Feature • The manifestation of neonatal septicemia are

subtel, vague and non- specific.

• The most common compliant concerning infant’s

progress is “ failure to do well” or “ not looking

right”.

• Hypothermia is a common manifestation.

R Dhaker, Lecturer, PCNMS 9

The signs of sepsis are non-specific and include:

• Body temperature changes

• Breathing problems• Diarrhea• Low blood sugar• Reduced movements• Reduced sucking

• Seizures• Bradycardia• Swollen belly area• Vomiting• Yellow skin and whites

of the eyes (jaundice)

R Dhaker, Lecturer, PCNMS 10

Cont… Clinical Feature

• Circulator system

– Pallor, cyanosis

– Cold, clammy skin

– Hypotension and

shock

– Edema

– Bradycardia or

tachycardia

• Respiratory system

Irregular

respiration , apnea,

Cyanosis

Grunting

Dyspnea

Retraction

R Dhaker, Lecturer, PCNMS 11

Cont… Clinical Feature

• Central Nervous System

–

– Reduced activity

( lethargy , coma, poor

cry)

– Irritability , tremors

– Full fontanel

– Abnormal eye

movement

• GI system-

• Poor feeding

• Vomiting

• Diarrhea or decreased

stool pass

• Abdominal distension

• Hepatomegaly

R Dhaker, Lecturer, PCNMS 12

Cont… Clinical Feature

• Hematopoietic

system- – Jaundice

– Pallor

– Ecchymosis

– Spleenomegaly

– Bleeding

• Feature suggestive of

pneumonia include-

• Tachycardia

• Chest retractions

• Early cyanosis

• Poor feeding

• Lethargy

R Dhaker, Lecturer, PCNMS 13

Diagnostic Evaluation • Blood Culture

• Urine examination

• CSF study

• CBC

• C- reactive protein

• ESR may be elevated ( >15 mm 1st hour)

R Dhaker, Lecturer, PCNMS 14

Management • For babies with neonatal sepsis,

–Supportive care and

–Antibiotic therapy

R Dhaker, Lecturer, PCNMS 15

Supportive care• Provide warmth • Start IV line. Infuse normal saline 10ml/kg over 5

to 10 minute. • Infuse 10%glucose, 2ml/kg stat to manage

hypoglycemia. • Administer injection vitamin K, 1mg IM to

prevent bleeding. • If the baby is cyanosed or grunting provide

oxygen via hood or mask.

R Dhaker, Lecturer, PCNMS 16

Cont… Supportive care

• If baby is Apneic provide physical stimulation and

bag – mask ventilation, if required.

• Avoid oral feeding if baby is very sick and given

intravenous fluid.

• In neonates with sclerema, exchange transfusion

with fresh whole blood may be required.

17

Antibiotic therapy • Antibiotic therapy should cover common

causative bacteria like E.coli, staphylococcus

aureus and klebsiella pneumoniae.

• A combination of ampicillin and gentamycian is

recommended for treatment of sepsis and

pneumonia.

R Dhaker, Lecturer, PCNMS

R Dhaker, Lecturer, PCNMS 18

Cont…Antibiotic therapy

IN Septicemia and Pneumonia • Injection Ampicillin 50 mg/kg/dose 12 hourly IV or

IM 7 to 10 days • Injection Gentamicin 2.5mg/kg/dose BD IV/IM, 7 to

10 days In Meningitis • Injection Ampicillin 100 mg/kg/dose 12 hourly IV 3

weeks • Injection Gentamicin 2.5mg/kg/dose BD IV, 3Weeks or • Injection Chloramphenicol 12mg/kg/dose BD IV,

3weeks

R Dhaker, Lecturer, PCNMS 19

Prognosis • The prognosis is variable. Sever neurological and

respiratory problem may occur in low birth weight

babies as a result of early onset sepsis.

• Late onset sepsis and meningitis may result in

poor outcomes.