Neonatal Sepsis

Neonatal Sepsis

Neonatal sepsis also known as sepsis Neonatrum/Neonatal septicemia

Neonatal sepsis occurs when pathogenic bacteria gain access into blood stream.

May cause septicemia or localize into lungs causing pneumonia or into meninges causing meningitis.

Blood infection that occurs in infants less than 90 days of age.

Types of Neonatal Sepsis

1. Early onset sepsis

2. Late onset sepsis

1. Early onset sepsis (EOS)

Early onset sepsis seen in first week of life.

Sepsis in neonates at or before 72 hours of life.

2. Late onset sepsis (LOS)

Late onset sepsis occuring after 72 hours to 90 days of life.

Causes of Early Onset Sepsis

1. Group B streptococcus infection during pregnancy

2. Preterm delivery and low birth weight baby

3. Premature repture of membrane (PROM)

4. Infection of placental tissue and amniotic fluid (chorioamnionitis).

5. Multiple prevaginal examination (pelvic examination)

6. Maternal fever and infection

Risk of Developing late onset septicemia 

Get infected after delivery by organism in external environment/home/hospital

1. Lack of aseptic technique followed by care giver.

2. Lack of Breastfeeding

3. Low birth weight/preterm babies

4. Hospital stay for long time

5. Umbilical sepsis/ superficial infection 

6. Having Intra-catheter in blood vessel for long time.

Painful sore developed in skin.

7. Low immunity

8. Mechanical ventilation

Clinical manifestations

1. Failure to thrive

2. Baby not active/ not respond

3. Baby temperature changes

Respiratory system 

4. Breath problem/Apnea

5. Respiratory Distress(in early onset sepsis)

6. Feeding difficultly (seen in late onset sepsis)

7. Pneumonia

Central nervous system 

7. Full fontanels

Gastrointestinal system 

8. Diarhoea

10. Vomiting

11. Abdominal distension

12. Poor feeding, refusal to suckle

13. Lethargy

Circulatory system 

14. Bradypnea or tachypnea

15. Bradycardia and tachycardia

17. Meningitis

Skin

18. Jaundice (yellowish discoloration of skin, white of eye, mucus membrane)

19. Pallor

Diagnostic Evaluation

1. Neonates birth history

2. Diagnosis of septicemia

a. Blood culture

b. Urine culture

c. CSF culture

3. Complete blood count (CBC)

Shows sign of anemia, leuKocytosis (increased WBC) or leucopenia (low WBC).

Elevated number of immature neutrophils and neutropenia 

Changes in neutrophil morphology

4. C- reactive protein is positive in septicemia

5. Erythrocyte Sedimentation rate (ESR) elevated

Management

Management with Neonatal Sepsis include;

1. Supportive care

Provide thermoneutral environment; if required provide warmth.

2. Start intravenous line.

If perfusion is poor (more than 3 seconds), infuse normal saline 10ml/kg over 5-10 minutes.

Check perfusion by capillary refill time.

To manage hypoglycemia; infuse 10% glucose; 2ml/kg

Administer vitamin K injection; 1mg intramuscular (IM) to prevent bleeding.

Provide oxygen via hood or mask; if baby is grunting r cyanosed

Physical stimulation and bag-mask Ventilation provided if baby is apneic.

If baby is very sick, give intravenous fluids, avoid oral feeding.

In neonates with sclerema (disorder in which hardening of adipose tissue/ subcutaneous tissue); exchange transfusion with fresh whole blood required.

2. Antibiotics therapy 

Antibiotics medication depends upon on causative organism detected on culture.

1. Septicemia and Pneumonia 

Injection Ampicillin 50mg/kg/dose and injection Gentamicin 2.5 mg/kg/dose  is recommended for treatment of sepsis and pneumonia.

2. Meningitis

Injection Ampicillin (100mg/kg/dose) and Injection Gentamicin (2.5mg/kg/dose) and injection Chloramphenicol (12mg/kg/dose).