Neonatal sepsis

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neonatal sepsis

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Neonatal sepsis

  1. 1. DR. V. VEERA RATNAKAR REDDY Senior resident. 05/08/14 Fr. Muller Medical College, Kankanady. 1
  2. 2. What is meant by sepsis ??  Systemic bacterial infections are known by the generic term neonatal sepsis. 05/08/14 Fr. Muller Medical College, Kankanady. 2
  3. 3. Definition Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. Incorporates septicemia, pneumonia, and meningitis of the newborn. Incidence approximately 30/1000 live births 05/08/14 Fr. Muller Medical College, Kankanady. 3
  4. 4. Etiology E.Coli, Staph aureus, Group B Streptococcus and Klebsiella sp. Are responsible for most cases.  MC CAUSE OF CONG PNEUMONIA-? As per aiims study both extramural and intramural cause of sepsis is in the order of: Klebsiella> s.aureus>e. coli. 05/08/14 Fr. Muller Medical College, Kankanady. 4
  5. 5. EARLY ONSET LATE ONSET ONSET <72 hrs >72 hrs SOURCE Maternal Nursery Organism Gp B Strept, E. Coli Gram –ve, Staph Aureus Maternal Risk Factors Present Absent Presentation Multisystem, Pneumonia Focal, Meningitis Course Fatal Recovery 05/08/14 Fr. Muller Medical College, Kankanady. 5 Types: EOS, LOS, VLOS
  6. 6. PREDISPOSING RISK FACTORS MAJOR PROM> 24 hrs Maternal Fever >38°C (Within 15 days) Foul Smell Liquor (Chorioamnionitis) Fetal distress (pr.lab) MINOR LBW Prematurity Birth Asphyxia Maternal WBC> 15,000 Vaginal Swab +ve for GBS 05/08/14 Fr. Muller Medical College, Kankanady. 6
  7. 7. Infant born through foul smelling liquor/ 3 of risk factors/ 1 major+2 minor require treatment with Abs  with 2 risk factors= needs to be investigated 05/08/14 Fr. Muller Medical College, Kankanady. 7
  8. 8. Complaints: non specific 05/08/14 Fr. Muller Medical College, Kankanady. 8
  9. 9. 05/08/14 Fr. Muller Medical College, Kankanady. 9
  10. 10. ???????//??/////???////??// 05/08/14 Fr. Muller Medical College, Kankanady. 10
  11. 11. Skin Infection
  12. 12. ????? 05/08/14 Fr. Muller Medical College, Kankanady. 13
  13. 13. SSS
  14. 14. Swelling left knee
  15. 15. Umblical Sepsis
  16. 16. Seizures
  17. 17. 05/08/14 Fr. Muller Medical College, Kankanady. 18
  18. 18. 05/08/14 Fr. Muller Medical College, Kankanady. 19
  19. 19. Septic Shock On Ventilator
  20. 20. CLINICAL PRESENTATION NON SPECIFIC- Lethargy, poor feeding, hypothermia/ fever, pale/ cyanosis MENINGITIS- Convulsions PNEUMONIA- Apnoea/ Resp. Distress NEC- Vomiting, Abd. Distension DIC- Bleeding PYELONEPHRITIS SHOCK Pathological JAUNDICE SCLEREMA 05/08/14 Fr. Muller Medical College, Kankanady. 21
  21. 21. DIAGNOSIS: SEPTIC SCREEN GOLDSTD INV: ??? & repeat t to be done? SEPTIC SCREEN: TC+ANC+INC/NC, +Mesr+CRP TC >20,000; <5,000 DC- Absolute Neutropenia, Band forms/Total > 20% PS- Toxic Granulations CRP >6mcg/ml. Micro ESR > 15mm LP: in eos- culture +ve, los-all & repeat lp GASTRIC ASPIRATE for polymorphs > 5/HPF Urine c/s: EOS: not indi, LOS: all 05/08/14 22
  22. 22. 05/08/14 Fr. Muller Medical College, Kankanady. 23
  23. 23. TREATMENT ANTIBIOTICS- Ampi+Genta; Cefotaxim+Amikacin SUPPORTIVE Fluid & electrolytes Shock/ Hypoxia/ Acidosis Nutrition Blood (DIC) Treatment of Hyperbilirubinemia 05/08/14 Fr. Muller Medical College, Kankanady. 24
  24. 24. Duration of AB COURSE: Meningitis (with or without positive blood/CSF culture) : 21 Blood culture positive but no meningitis:14 Culture negative, sepsis screen positive and clinicalcourse consistent with sepsis: 7-10 Culture and sepsis screen negative, but clinical coursecompatible with sepsis: 5-7 Arthritis, endocarditis, osteomyelitis: 4 -6w Ventriculitis: 6wk 05/08/14 Fr. Muller Medical College, Kankanady. 25
  25. 25. NEWER MODALITIES Double volume exchange transfusion Cytokines (GM-CSF, G-CSF, γ Interferon) Immunoglobulins Fibronectin- large molecular weight glycoprotein  ↑ neutrophil & macrophage response to infection 05/08/14 Fr. Muller Medical College, Kankanady. 26
  26. 26. Summary Systemic infections in newborn is known as neonatal sepsis. Clinical symptomatology is vague and non-specific Mortality is high among LBW babies and gram negative sepsis. Combination of Cefotaxim and Amikacin found to be a better combination. 05/08/14 Fr. Muller Medical College, Kankanady. 27
  27. 27. This to this 05/08/14 Fr. Muller Medical College, Kankanady. 28
  28. 28. Thank you 05/08/14 Fr. Muller Medical College, Kankanady. 29

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