Neonatal sepsis...ppt
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Neonatal sepsis...ppt
- 1. Neonatal Sepsis 1R 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 2
- 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 3
- 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 4
- 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) R Dhaker, Lecturer, PCNMS 5 Cont… Etiology
- 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 6
- 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 7
- 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 8
- 9. The signs of sepsis are non-specific and include: • Body temperature changes • Breathing problems • Diarrhea • Low blood sugar • Reduced movements • Reduced sucking R Dhaker, Lecturer, PCNMS 9 • Seizures • Bradycardia • Swollen belly area • Vomiting • Yellow skin and whites of the eyes (jaundice)
- 10. Cont… Clinical Feature • Circulator system – Pallor, cyanosis – Cold, clammy skin – Hypotension and shock – Edema – Bradycardia or tachycardia R Dhaker, Lecturer, PCNMS 10 • Respiratory system Irregular respiration , apnea, Cyanosis Grunting Dyspnea Retraction
- 11. Cont… Clinical Feature • Central Nervous System – – Reduced activity ( lethargy , coma, poor cry) – Irritability , tremors – Full fontanel – Abnormal eye movement R Dhaker, Lecturer, PCNMS 11 • GI system- • Poor feeding • Vomiting • Diarrhea or decreased stool pass • Abdominal distension • Hepatomegaly
- 12. Cont… Clinical Feature • Hematopoietic system- – Jaundice – Pallor – Ecchymosis – Spleenomegaly – Bleeding R Dhaker, Lecturer, PCNMS 12 • Feature suggestive of pneumonia include- • Tachycardia • Chest retractions • Early cyanosis • Poor feeding • Lethargy
- 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 13
- 14. Management • For babies with neonatal sepsis, –Supportive care and –Antibiotic therapy R Dhaker, Lecturer, PCNMS 14
- 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 15
- 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. R Dhaker, Lecturer, PCNMS 16
- 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 17
- 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 18
- 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. R Dhaker, Lecturer, PCNMS 19