What is neonatal sepsis?
- a bloodstream invasion by bacteria or the toxic materials produced by bacteria
- a major cause of morbidity &
... [Show More] mortality
When does neonatal sepsis usually occur?
less than 36 weeks gestational
How often does neonatal sepsis occur?
1 in 8 infants
What are some risk factors for developing neonatal sepsis?
- immature barrier defense mechanism
- a deficient immunologic response
- increased use of instrumentation
- prenatal or perinatal exposure
- increased length of hospital stay
Maternal Conditions that predispose neonates to sepsis
- prolonged rupture of membranes longer than 24 hours before birth
- extent of life support procedures required postnatally
Which are the most common bacterial causes of neonatal sepsis?
"GEL"
- Group B. Streptococci
- E. coli
- Listeria
What are the most common viral causes of neonatal sepsis?
- Herpes Simplex Enterovirus
- Adenovirus
What is the most common fungal cause of neonatal sepsis?
Candida
What are the most common protozoal causes of neonatal sepsis?
- Malaria
- Borrelia
Early-Onset Neonatal Sepsis
- occurs within the first 3 days of life
- more common in neonates weighing less than 1.5 kg (a.k.a. 1500 g)
What is the mortality rate of early-onset neonatal sepsis in preterm infants?
60%
How can early-onset neonatal sepsis be contracted?
- transplacental hematogenous spread throughout pregnancy
- direct fetal exposure to organisms when passing through the birth canal
- perinatal vertical transmission from the birth canal to the amniotic sac
- extra-uterine exposure immediately after delivery
What organisms are usually responsible for the hematogenous transmission of early-onset neonatal sepsis?
"His Last Relationship Cost Tom Victoria Secret"
- Human Immunodeficiency Virus (HIV)
- Listeria monocytogenes
- Rubella
- Cytomegalovirus (CMV)
- Toxoplasmosis (found in cats)
- Varicella zoster
- Syphilis
What organisms are usually responsible for perinatal/vertical transmission of early-onset neonatal sepsis?
"Girl, Call Eve & Pray God Sends Help"
- Group B. Streptococci (GBS)
- Chlamydia
- E. coli
- Pseudomonas aeruginosa
- Gonococci
- Staphylococcus aureus
- Haemophilus influenzae
The most common causes of early-onset neonatal sepsis are..?
"GEL"
GBS
E. coli
Listeria
Group B. Streptococci (GBS)
- gram (+) diplococci
- colonizes the genital or lower GI tracts
- most prevalent in AA women & Diabetes Mellitus patients
Maternal Risk Factors for GBS
- previous delivery of infant with invasive GBS infection
- GBS bateriuria during pregnancy
- delivery at less than 37 weeks gestation
- duration of ruptured membranes greater than 18 hours
- intrapartum temperature greater than 38 C (or 100.4 F)
What is the process of prophylaxis in GBS?
1) obtain a vaginal or rectal swab between 35 & 37 weeks gestation
2) if cultures are positive or patient's infection has risk factors, treatment should begin during labor
GBS Treatment
1) Penicillin
- 5 million units IV, then 2.5 to 3 mill IV q 4 h until delivery
2) Ampicillin
- 2 g IV followed by 1 g q 4 h
- if membrane is ruptured, 2 g IV followed by 1 g q 6 h until delivery
3) Cefazolin
- 2 g IV followed by 1 g q 8 h until delivery
How do you treat GBS if the patient has a PCN allergy?
Clindamycin
- 900 mg IV q 8 h until delivery
- studies have shown potential for resistance development
E. coli
- 2nd most common cause of early-onset neonatal sepsis
- colonizes in the cervix and GI tract
Maternal Risk Factors for E. coli
- UTIs
- intrapartum fever
- prolonged membrane rupture
- assisted delivery
- multiple births
E. coli Treatment
1) Ampicillin
- 2 g IV q 6 h
2) Erythromycin
- 250 mg IV q 8 h for 48 hours followed by po doses of these ABX for 5 days
What is the salt form of Erythromycin that is contraindicated in pregnancy?
Estolate (causes hepatitis)
Late-Onset Neonatal Sepsis
- occurs more than 3 days postpartum
- community-acquired
- 93% occur in infants weighing less than 1.5 kg (a.k.a. 1500 g)
The most common causes of late-onset neonatal sepsis are..?
- Coagulase-negative Staphylococci (Staph. epididermis)
- Gram-negative Bacilli
- Candida species
- GBS
What are the most common causes of late-onset neonatal sepsis in VLBW ("very low birth weight") neonates?
- Candida
- Coagulase-negative Staphylococci
What are the clinical manifestations of late-onset neonatal sepsis?
- feeding intolerance
- respiratory distress
- apnea
- bradycardia
- lethargy
- temperature instability
- glucose intolerance
- hyperbilirubinemia
How often should a neonate feed?
Breast = 2 to 3 hours
Formula = 3 to 4 hours
When can a diagnosis of diabetes be made on a child?
Type 1 = greater than 2 years of age
Type 2 = 10 to 12 years of age [Show Less]