Download NEONATAL SEPSIS

By Dr. Gacheri Mutua
 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
EARLY 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
LATE ONSET





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
 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
 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
 Septic
baby should be managed in the Special
Care Nursery where they can be observed
closely
 General measures:



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Thermal care
Incubator nursing
Phototherapy if warranted
Monitoring of oxygen saturation, heart rate and
BP
 Respiratory:

Support for apnoea, hypoxia, hypercapnoea and
respiratory distress

Cardiovascular:
Plasma volume expanders like Normal Saline 1020mls/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

 Early


Benzylpenicillin 60mls/kg 12hrly, if meningitis
suspected 120mg/kg/dose 12hrly
Gentamicin 5mg/kg IV 36hrly if >1200g, 48hrly if
<1200g
 Late



onset:
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
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
