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6 Neonatal Septicemia

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  • 1. Neonatal Septicemia Mbbs.weebly.com
  • 2. Will They Have Good Future ???
  • 3. Objectives What will I learn? Etiologies and risk factors Symptoms Diagnosis Treatment
  • 4. Introduction
    • Common
    • -20% of VLBW has sepsis
      • -In term 0.1%
      • -Inter-institution difference 11-32%
      • (NICHD net work)
    • Serious
      • -mortality is 3-5 times more for infant
      • with sepsis in NICU
  • 5.  
  • 6. What is Neonatal Sepsis?
    • Neonatal Septicemia is a generalized
    • infection characterized by the proliferation
    • of organisms in the blood circulation during
    • the first month of life.
  • 7. Some basic definitions
    • SIRS(systemic inflammatory response syndrome )
    • - fever, tachypnoea, tachycardia, abnormal WBC
    • Sepsis- systemic response to infection
    • Severe sepsis- sepsis with organ dysfunction, hypotension
    • Septic shock- severe sepsis with multiorgan dysfunction
    • difficult to apply these definitions and a staging system to the newborn
  • 8. Pathogen
    • Staphylococcus
    • Escherichia coli
    • Conditional pathogen
    • Group B streptococcus
  • 9. Staphylococcus
  • 10. E. Coli
  • 11.
    • Staphylococcus epidermidis
  • 12.
    • Pseudomonas aeruginosa
  • 13. Klebsiella
  • 14.
    • Clostridium perfringens
  • 15. Group B -hemolytic streptococcus
  • 16. Route of Infection
    • Prenatal infection
    • infection during delivery
    • postnatal infection
  • 17. Sepsis Risk Factors
    • Prematurity
    • Birth weight
      • Term 0.1%
      • 1,000 -1,500 g 10%
      • <1,000 g 35%
      • <750 g. 50%
    • Delay enteral feeding and Prolonged TPN
  • 18.
        • Risk Factors (maternal and neonatal)
        • Major
          • Maternal prolonged Rupture of Membranes >24 hours
          • Intrapartum maternal fever >38 C (>100.4 F)
          • Chorioamnionitis
          • Sustained Fetal Tachycardia >160 beats per minute
        • Minor
          • Intrapartum maternal fever >37.5 C (>99.5 F)
          • Twin Gestation
          • Premature infant (<37 weeks)
          • Maternal Leukocytosis ( White Blood Cell count >15000)
          • Rupture of Membranes > 12 hours
          • Tachypnea (<1 hour)
          • Maternal Group B Streptococcus Colonization
          • Low APGAR (<5 at 1 minute)
          • Low birth weight (<1500 grams)
          • Foul lochia
  • 19. What makes a neonate’s immune system susceptible to sepsis? Maturity Immaturity or
  • 20. You’re Right!!!! The immaturity of a neonate’s immune system makes them MORE SUSCEPTIBLE to sepsis.
  • 21. Why are newborns so vulnerable to infection? Non-specific immunity Specific immunity
  • 22. Why are newborns so vulnerable to infection? IMMUNE SYSTEM Neutrophils – Qualitative and quantitative Complement and immunoglobulin levels decreased T cells- antigenically naïve limited cytokine production
  • 23.
    • Poor skin barrier
  • 24.
    • Umbilical stump
  • 25.
    • Poor blood-brain barrier
  • 26. Classification
    • Early onset sepsis (EOS):
      • bacteria acquired before and during delivery
      • 5-7/1000 live birth
      • 1.5% of VLBW infants had EOS (intrapartum antibiotics)
    • Late onset sepsis (LOS):
      • bacteria acquired after delivery (Nosocomial or community)
      • 20% of VLBW infants
  • 27. Clinical menifestations EOS LOS Onset Within 7 days >7 days Source Prenatal During delivery During delivery Postnatal(nosocomial ) Pathogens G - bacili S taphylococcus ; Opportunitic P resentation Mortality P neumonia High Bacteremia and / or meningitis Low
  • 28. Symptoms of Neonatal Sepsis The symptoms of are not concrete and vary widely Tachypnea Heart Rate Changes Feeding difficulties Difficulty Breathing Temperature Instability J aundice Irritability
  • 29. Omphalitis
  • 30. Bleeding tendency Poor perfusion
  • 31. Enlargement of liver and spleen
  • 32. toxical paralytic ileus
  • 33. NEC
  • 34. NEC
  • 35. dyspnea
  • 36. Clinical presentation Early warning signs are often non-specific and subtle  easily confused with non-infective causes (e.g. apnea of prematurity, variation in environmental temperature or acute exacerbation of chronic lung disease)  clinical course alarmingly fulminant  septic shock + DIC  death Non-specific, multi- systems/organs involved
  • 37. Clinical manifestation The symptoms are so broad , non-specific , and acute deterioration , How to make a diagnosis as early as possible ?
  • 38. Laboratory studies
    • Evidence for inflammation
    • Evidence for infection
    • Evidence for multiorgan system disease
  • 39. Laboratory Examination: CBC
    • WBC<5×10 9 /L or WBC>20× 10 9 /L
    • I/T≥0.2 , toxic granules
    • thrombocytopenia <100×10 9 /L
  • 40. Reference values for neutrophilic cells Manroe BL, J Pediatr 1979;95:89-98.
  • 41. Total neutrophils Immature neutrophil I/T ratio
  • 42.  
  • 43. Lab examination:CRP
    • CRP
    • α1-AG
    • α1-AT
  • 44. Lab Exam: Organism detection  blood culture  culture of body fluid and secretion  plasma brown layer smear --Detection of antigen: usually for antibody of GBS or E coli in CSF, blood and urine --Molecular biochemical method PCR
  • 45. Summary Is there a diagnostic marker for neonatal sepsis?
  • 46. Great answer! You’re correct!
    • There is NOT a specific diagnostic marker, only determinants of infection
  • 47. Summary
    • The best approach for diagnosis of systemic bacterial infection:
    • use of multiple markers (e.g. CRP, IL-6, TNF  , CD64), and
    • serial measurements
  • 48. Diagnosis
    • history
    • – high risk factors
    • clinical manifestation
    • --nonspecific S/S
    • lab results
    • - abnormal blood routine,
    • CRP, positive culture
    • or detection of organisms
  • 49. Therapy
    • Infection should be the first thought when an infant has symptoms
    • Aggressive treatment should begin before the diagnosis is confirmed.
    • Therapy can be discontinued if sepsis is excluded
  • 50. Treatment  Antibiotics therapy  management of complications  supporting therapy  Clearance of infectious focus  Immunotherapy
  • 51. Antibiotic therapy
    • using antibiotics as early as possible
    • choose antibiotics according to drug sensitivity
    • giving drugs intravenously
    • combine effective drugs to make synergism
    • enough therapeutic course
    • consider the possible side effects
  • 52. Dosages of antibiotics for newborns
  • 53. Supporting therapy
    • Nursing care
    • --warm environment
    • --oxygen supply
    • correction of acidosis and electrolyte disturbance
    • fluid , glucose and nutrition balance
  • 54. Management of complications
    • Shock
    • DIC
    • Cerebral edema
    • Pulmonary hemorrhage
  • 55. Immunotherapy
    • IVIG
    • Exchange transfusion
    • Granulocyte transfusion , G-CSF
    • Platelet transfusion
  • 56. Questions
    • Could prophylatic IVIG reduce the morbidity and mortality of neonatal sepsis?
    • Might prophylatic IVIG interfere the development of the neonatal IM system?
  • 57. Mbbs.weebly.com