Septicemia neonatorum• Sepsis of the neonate• A generalized infection• Characterized by the proliferation of bacteria in the bloodstream and commonly involves the meninges• High mortality
Etiologic Agents• Gram-negative organisms o Escherichia coli o Klebsiella (Enterobacteriaceae) o Pseudomonas o Proteus o Salmonella o Hemophilus influenzae
• Gram-positive organisms o group B beta-hemolytic Streptococcus o Listeria monocytogenes o Staphylococcus aureus (coagulase-negative and coagulase-positive) o Staphylococcus epidermidis o Streptococcus pneumoniae o Streptococcus faecalis
• Fungal infections from the organism Candida albicans are increasing in incidence, especially in the low- birth-weight neonate• Infection occurs because of a temporary breakdown or depression of the neonates defense mechanism for an unknown reason
Predisposing factors• Wide range of maternal perinatal complications• Iatrogenic factors o Use of catheters, oxygen, resuscitative equipment• Infant complications o Prematurity, congenital anomalies, RDS, skin infections, asphyxia
NURSING ASSESSMENT ANDINTERVENTIONS
• Be alert for early signs of sepsis, which are usually vague and subtle o Poor feeding; gastric retention; weak sucking o Lethargy, limpness; weak crying. o Temperature alteration— generally hypothermia, but infant may have hyperthermia o Hypoglycemia or hyperglycemia
• Assist with diagnostic tests. o Cultures from the blood, urine, spinal fluid, skin lesions, nose, throat, rectum, gastric fluid. o WBC and differential, hemoglobin, hematocrit. o Blood chemistries—glucose, calcium, pH, electrolytes.
o C-reactive protein and erythrocyte sedimentation rate.o Acid-base studies (acidosis).o Bilirubin.o TORCH (toxoplasmosis-rubella- cytomegalic inclusion virus- herpes-other) detects antibodies against common intrauterine- infective agents.
o ABG values.o Chest X-ray—may demonstrate pulmonary infection.o Urinalysis.
• Assist with treatment. o Before the specific organism is identified, and after cultures have been obtained, the antibacterial therapy is based on the more common causative agents and their anticipated susceptibilities.
o Supportive therapy includes: observation, isolation, hydration, nutrition, oxygen, regulation of thermal environment, blood transfusion to correct anemia and shock, and protection from further infection.
• Observe for complications: o Meningitis (very common) o Shock o adrenal hemorrhage o disseminated intravascular coagulation o PPHN o metabolic derangements o Seizures o Pneumonia o UTI o heart failure