THIS SLIDE INCLUDES THE MANAGEMENT AND PREVENTION OF NEONATAL INFECTIONS. IF ANY SUGGESTION GIVE IT IN COMMENT BOX.

1. SEMINAR ON
NEONATAL INFECTION,
PREVENTION AND
MANAGEMENT
BY,
MR. ABHIJIT BHOYAR
M. SC. NURSING
CHILD HEALTH

2. GENERAL OBJECTIVES –
• At the end of the topic the student will be able
to gain the knowledge about the neonatal
infections and able to do the care of neonate
in the hospital.

3. SPECIFIC OBJECTIVES –
At the end of the seminar the student will be
able to.
• Define the neonatal infections.
• Enlist the etiological factors of the neonatal
infection.
• Enlist the some common neonatal infection

4. • Discuss about the common infections and
there management.
• Discuss about the prevention of neonatal
infection.

5. INTRODUCTION
• Neonatal infection is the clinical syndrome of
multiplying bacteria in the blood with systemic signs
and symptoms of inflammation.
• Newborn infants are at a higher risk of contracting
various infections. Prenatal infections, especially
neonatal bacterial infection is the commonest cause
of neonatal mortality in India

6. • Infection can occur in intrauterine life or
during delivery or in the neonatal period. The
neonates are more susceptible to infection
because they lack in natural immunity and
take some time for the development of
acquired immunity.

7. DEFINITION
• Neonatal infection is systematic bacterial
which incorporates septicemia, pneumonia &
meningitis of newborn.

8. INCIDENCE
• Black infants have an increased incidence of
GBS disease and late-onset sepsis.
• This is observed even after the risk factors of
low birth weight and decreased maternal age
have been controlled for.

9. • In all races, the incidence of bacterial sepsis
and meningitis, especially with gram-negative
enteric bacilli, is higher in males than in
females
• Premature infants have an increased incidence
of sepsis.

10. • The incidence of sepsis is significantly higher in
infants with a birth weight of less than 1000 g (26 per
1000 live births) than in infants with a birth weight of
1000-2000 g (8-9 per 1000 live births).
• The risk of death or meningitis from sepsis is higher
in infants with low birth weight than in full-term
neonates.

11. ETIOLOGY
Antenatal period
• Intrauterine infection
• Ascending infection with contaminated liquor
amnii and amnionitis related to infected birth
passage and premature rupture of membrane

12. • Intranatal period
• Aspiration of infected liquor
• repeated vaginal examination
• Infected birth passage
• Improper aseptic techniques

13. Postnatal period
• human contact or care givers
• Cross infection from other
babies
• Infected article
• Invasive procedure
• Infected environment

14. Risk factors
• Maternal GBS colonization (especially if untreated
during labor)
• Premature rupture of membranes (PROM)
• Preterm rupture of membranes
• Prolonged rupture of membranes
• Prematurity
• Maternal urinary tract infection
• Chorioamnionitis

15. OTHER
FACTORS
Congenital
anomalies
Meconium
staining
Low Apgar
score
Maternal
fever Maternal
UTI
Poor
prenatal
care
Low
socioecono
mic status
History of
recurrent
abortion
Birth
asphyxia
Low birth
weight
Maternal
substance
abuse
Difficult
delivery

16. COMMON INFECTION IN NEONATE
SUPERFICIAL
• Eyes,
• Skin,
• Umbilicus, And
• Oral Cavity.
LOCALIZED OR
SYSTEMIC
• septicemia ,
• DIC(disseminated
intravascular
coagulopathy),
• pyelonephritis

17. The presence of three of the following
feature should make alert to the
possibility of intrauterine infections
• Maternal history of
infection
• Intrauterine growth
retardation
• Hepatosplenomegaly
• Jaundice
• Petechie and purpura
• Meningo-encephalitis(with
microcephaly,
hydrocephaly, cerebral
calcification, cataract)
• Osteochondritis
• Raised IgM in cord blood.

18. NEONATAL CONJUNCTIVITIS
( ophthalmia neonatorum)
DEFINITION -Inflammation of conjunctiva during first
three week of life is term as ophthalmia
neonatorum.
• Sticky eyes without purulent discharge are common
during first 2 to 3 days after birth
• Unilateral conjunctivitis
after 5 days (Chlamydia
trachomotis)

19. • Purulent discharge (gonococcus ) affect one or
both eyes within 48 hours of age.
• Other microorganism causing neonatal
conjunctivitis are streptococcus , staphylococcus,
pnenmonia , E. coli, herpix simplex virus, etc
• chemical conjunctivitis may occure due to
irritation of silver nitrate , soap and local
antibiotic drops.

20. Mode of infection
• Infected hands of caregiver,
• Infected birth canal and
• Cross infection from other baby.
• Infection can occurs directly from other sites
of infection like skin and umbilicus.

21. Clinical features
• White sticky eyes with or without discharge
ranging from watery or purulent or mucopurulent
in one or both eyes.
• The eyelid may be markedly swollen and stuck
together with redness of eyes.
• Closed eyelid may present due to spasm of ocular
muscle.

22. Management
• Antibiotic therapy (as eye drop or in
parenteral route
• The baby should be kept isolated to prevent
cross infection.
• Sulfacitamide or framacetin or
chloramphinicol drops or erythromycin
ointment can be used

23. • For gonococol infection penicillin therapy
should be initiated
• If organism are resistance to penicillin, then
cefotaxim or ceftraxone are used.

24. • Cleaning of the infected eyes with sterile
cotton swabs soaked in saline should be done
after hand washing
• Instillation of eye drops to be done with
proper aseptic technique.

25. Preventive management
• Treatment of maternal infection,
• Aseptic techniques during delivery ,
• Special care and attention in face and breech
presentation,
• Isolation of the infected baby
• Maintenance of general cleanliness.

26. Prognosis
• Prognosis is good if detected and treated
promptly
• In neglected cases, orbital cellulitis and
dacrocystic with obstruction of nasolacrimal
duct may develop.

27. • In gonococcus infection, corneal ulceration
may occur leading to cornial opacity.
• In rare cases blindness may occur if no
treatment done.

28. • UMBILICAL SEPSIS
(omphalitis)
The incidence of umbilical sepsis is reduced due to
aseptic technique and clean practices at birth.

29. source of infection
• Unhygienic environment of delivery.,
• Umbilical catheterization,
• Exchange transfusion,
• Contaminated cord cutting instrument,
• Infected hands of caregiver or infected
clothing

30. • The causative organisms are mainly
staphylococcus, E. coli, or any pyogenic
organisms.
• Clostridium tetani can also infect umbilical
cord and produces tetanus neonatorum.

31. • The incidence of tetanus neonatorum is also
reduced due to administration of tetanus
toxoid to antenatal mothers. But till it is found
in the rural area in home delivery and delivery
in very unhygienic condition.

32. Clinical features
• Swollen and moist
periumbilical tissue with
redness,
• Foul smelling and serous
and seropurulent discharge,

33. `• Delayed falling off umbilical cord and fever.
• Jaundice and features of septicemia may
appear in complicated cases.
• The clinical features of tetanus are found in
clostridium tetani infections.

34. Management
• Management of this condition is done with
dressing or the infected cord with triple dye or
sprit or antibiotic powder or lotion.
• Umbilical cord should leave uncovered rather
than application of dressing..

35. • Antibiotic
• The infected babies should be kept in the
isolation.
• Culture and sensitivity test of umbilical swab
may be needed in some cases who are not
responding to the routine treatment

36. • Umbilical sepsis can be complicated with
thrombophlebitis of umbilical veins, umbilical
granuloma, hepatitis, liver abscess, peritonitis
and portal hypertension

37. Prognosis
• Prognosis depends upon the nature of
infection, initiation of management and
nursing care.
• Prevention of umbilical infection is more easy
and important in life of neonates.

38. ORAL THRUSH
• It is fungal infection of the oral cavity and
tongue by Candida albicans in the late first
week or second week of age.
• Infection occur from infected birth canal,

39. • Infected feeding bottles and
• Teats or contaminated feeding articles,
mothers hands and breast nipples.
• It may develop due to prolonged antibiotic
therapy.

40. Clinical manifestation
• Milky-white elevated patches on the buccal
mucosa, lips, tongue and gums, which cannot
be easily wiped off with gauze and oozes
blood on attempt to scrap the patches.

41. • Swallowing difficulties may present due to
posterior oropharengeal white patches.
• Sucking reflex may be normal.
• infection may cause monilial diarrhea,
Perineal moniliasis and lung infection.

42. Management
• Oral application 0.5 percent aqueous solution
of gentian violet after each feed.
• Nystatin and ketokonazol or cotrimazole
lotions ; 4 times per day for 5 to 7 days.
• Parenteral antifungal drugs can be
administered in disseminated candidiasis.

43. Prevention
• This condition can be prevented by the
treatment of maternal fungal infection,
adequate cleaning of the utensils and
maintenances of general cleanliness and
hygienic measures.

44. PYODERMA
• Superficial skin infection (staphylococcus
aureus).
• The skin eruptions and pastules are commonly
seen on scalp, neck, groin and axillae.
• These are more commonly found in summer
month.

45. • This infection occurs from contaminated hands of the
personnel responsible for care of the neonate.
• Unhygienic environment,
• spread from other infected baby and
• contaminated baby clothing can also result in this
infections.

46. Clinical manifestation
• The infection may spread to cause abscess,
osteomyelitis, parotitis and septicemia,
• The life threatening staphylococcal infection may
result in pemphigus neonatorum that is
manifested as marked erythemia, bullas lesion
and exfoliation which gives appearance of scaled
skin syndrome.

47. Management
• Treatment of these lesions includes
puncturing, cleaning with hexachlorophene,
• Antiseptic skin care and application of triple
dye over the punctured lesions.
• Pus should be sent for culture and sensitivity
test..

48. • In case of spread infection, erythromycin 50
mg/kg per day per orally in 3 divided doses
• In complicated cases, parenteral
administration of antibiotic should be done.
• The baby to be kept in the isolation

49. Prevention
• This condition can be prevented by avoidance
of dip baby bath in hospital delivery and
during hospital stay, isolation of infected baby,
maintenances of general cleanliness (including
clean clothing ) and treatment of source of
infection.

50. Prognosis
• Prognosis is usually good if treated promptly
and good nursing care is provided.

51. TETANUS NEONATORUM
• Till recently tetanus neonatorum accounted
for the 6.5 percent of deaths in India.
• Every year nearly 230-280 thousands
neonates used to die within first month of life
due to neonatal
tetanus.

52. • The disease is caused by infection of umbilical
stump by clostridium tetani.
• Contamination of infectioin of the umbilical
stumps at the time of cutting the cord is an
important cause.
• The condition is limited to domociliary midwifery,
as untrained dais use unclene sharp weapons to
cut the umbilical cord.

53. • They even paint the stump with cowdung with
the mistaken belief of its purifying properties.
• Lack of active immunization of adult
population with tetanus toxoid also
contributes to the high incidence of this highly
fatal though entirely preventable disease.

54. Clinical features
• Common age of onset of symptoms is 5-15 days
• Excessive unexplained crying, follow by refusal of
feed and apathy
• The infant keeps the mouth slightly opened to
pull as a result of spasm of the muscle of the neck
but reflex mouth during feeds

55. • Reflex spasm of pharyngeal muscle lead to
dysphagia and chocking during feeds.
• During handling and touching, lock-jaw or
trismus is follow by spasm of the limbs.
• The usual flexed posture of the baby is replaced
by generalized rigidity and opisthotonus in
extension.

56. • The spasm of larynx and respiratory muscles is
associated with apnea and cyanosis. The
spasms are characteristically induced by
stimuli of touch, noise and bright light.
• Frequently muscular spasm lead to fever,
tachycardia and Tachypnea.

57. Management
• Active immunization of the pregnant women
against the tetanus
• Public health education regarding the need for
asepsis while cutting the umbilical cord, have
effectively reduced the incidence of tetanus
neonatorum.

58. General measures
• The infant should be nursed in a quite room.
• Handling should be reduced
• Intramuscular injections must be avoided,
• Temperature should be watched and controlled.
• Oral secretion should be suck periodically.

59. Intravenous infusion
• Oral feeding should be stopped
• Intravenous line should be established,
• Provide adequate fluids, calories, and electrolytes, it
offers a convenient route for administration of various
drugs.
• After two to three days, milk feeding through
nosogastric tube may be started.

60. Antitoxin serum
• Human tetanus specific immunoglobulin in
single dose of 250 i. u./kg intravenously
generally sufficient higher doses have not
shown to be of any additional benefits.

61. • The use of intrathecal antitetanus serum (250
units of human tetanus specific
immunoglobulin)appear to conform additional
therapeutic benefit by bathing and traveling
along the nerve roots to inactivate the toxins.
• It is not associated with the any serious side
effects.

62. Sedation
• Diazepam 2 to 5 mg (maximum of 2 mg/kg per
dose)
• Chlorpromazine 2mg/kg/dose should be
administered slowly intravenously every 2 to 4
hours, altering with each other , so that a
sedative dose is being given every1 to 2 hours.
• Phenobarbitone should preferably be avoided
during diazepam therapy to safeguard against
apnea attacks.

63. Muscle relaxants
• Methacarbanol (50-75 mg/kg/day iv in 2
divided doses)
• Mephenesin (30-120 mg/kg/dose every one
hourly orally)
Antibiotics
• penicillin, gentamicin or amicasin cefotaxim
should be given intravenously.

64. Tracheostomy or assisted ventilation
• Early resort to assisted ventilation along with
muscle relaxants has significaltly improved the
outlook in tetanus neonaterum.
• It is indicated that whenever the infant gets
frequent episodes of laryngeal spasm. Apneic
attack with cyanosis or central respiratory
failure.

65. Prognosis
• The overall mortality rate varies from 50- 75 %
but those who servieves do not manifest any
mental sequallae except when apneic
episodes are unduly prolong and unattended.

66. NEONATAL SEPSIS
Definition
• The systemic bacterial infections of neonates
are termed as neonatal sepsis which
incorporates septicemia, pneumonia and
meningitis of the newborn.

67. Etiological factors
klebsiella
pneumonia
,
staphylococ
cus aureus,
E. coli,
pseudomon
as
aeruginosa

68. Predisposing factor
• Intrauterine Infections,
• Premature Rupture Of
Membrane,
• Muconium Stained
Liquor,
• Repeated Vaginal
Examination,
• Maternal Infections,
• Lack Of Aseptic
Practices,
• Birth asphyxia,
• Resuscitation without
aseptic precaution,
• Low birth weight,
• Invasive procedure ,
• Needle pricks,
• Superficial infections,
• Aspiration of feed and
• lack of breast feeding.

69. sources of infection
• Infusion sets, IV sites,
• Face masks, feeding bottles,
• Catheters, ventilators,
• Resuscitators, incubators,
• Baby care contaminated
articles,
• Infected care givers and
unhygienic environments.

70. TYPES
•EARLY ONSET SEPSIS
• In The First 48 Hours After
Birth
• Associated with acquisition
of microorganisms from the
mother.
• Trans-placental infection or
an ascending infection from
the cervix
•LATE ONSET SEPSIS
• After 48 hours of age
• acquired from the care
giving environment.
• It acquired as nosocomial
infection from baby care
area or due to,inappropriate
neonatal care.

71. Clinical manifestation
• Early onset neonatal sepsis may present as
perinatal hypoxia, resuscitation difficulties and
congenital pneumonia in the form of respiratory
distress.
• The late onset neonatal sepsis in a very small
baby may be silent who may die suddenly
without presenting any signs and symptoms.

72. • lethargic, inactive, pale or unresponsive and
refuses to suck.
• Hypothermia is common than fever, in neonatal
sepsis.
• Poor cry, vacant look, comatose and not
arousable
• baby with distension of abdomen, diarrhea,
vomiting,
• less weight gain or loss of weight and poor
neonatal reflexes.
• episodes of apnea or gasping may be the only
feature of the condition.

73. • In Sick neonate, skin may become tight giving
a hide bound feel (sclerema) and poor
perfusion are found.
• In critical neonate circumpolar cyanosis,
shock, bleeding, excessive jaundice and renal
failure may develop.

74. • The evidence of pneumonia may include fast
breathing. Chest retraction, grunting, early
cyanosis, apneal spell in addition to inactivity
and poor feeding.
Cough is unusual.

75. • Meningitis is often silent, the clinical features
are dominated by manifestation of
septicemia. But the presence of high pitched
cry, fever, irritability, convolutions, twitching,
blank look, neck retraction and bulging
fontanel are highly suggestive of meningitis.

76. • The neonatal sepsis may present with
hypoglycemia, urinary tract infection,
coagulopathy (DIC) , necrotizing enterocolitis
(NEC) ,

77. Investigation
• history taking & physical examination,
• blood culture, swab culture from septic
umbilicus or from any other location of
superficial infections and lumber puncture for
CSF study.
• Other useful investigation are urine for routine
examination and culture, chest x ray , blood
sugar, serum bilirubin, leucocytes count, ESR c-
reactive protein, for sepsis screening procedures.

78. MANAGEMENT
• Cardiopulmonary support and intravenous (IV)
nutrition may be required during the acute
phase of the illness until the infant’s condition
stabilizes.
• Monitoring of blood pressure, vital signs,
hematocrit, platelets, and coagulation studies
is vital.

79. • Blood product transfusion, including packed
red blood cells (PRBCs), platelets, and fresh
frozen plasma (FFP), is indicated
• An infant with temperature instability needs
thermoregulatory support with a radiant
warmer or incubator. Once the infant is stable
from a cardiopulmonary standpoint, parental
contact is important.

80. • Surgical consultation for central line
• If an abscess is present, surgical drainage may
be necessary;
• IV antibiotic therapy cannot adequately
penetrate an abscess, and antibiotic
treatment alone is ineffective.

81. Additional therapies
• granulocyte transfusion,
• IV immune globulin (IVIg) infusion
• exchange transfusion,

82. Supportive care
• Maintenance of warmth
• Intravenous fluid should be administered
• Oxygen therapy should be provided
• Bag and mask ventilation with the oxygen
therapy
• Vitamin k 1mg intramuscularly should be
given

83. • Enteral feed is avoided if the neonate is very
sick or has abdominal distension
• Other supportive measure includes gentle
physical stimulation, nasogastric aspiration,
close and constant monitoring of infants
condition and experts nursing care.

84. Antibiotic Therapy
• Ampicillin
• Vancomycin
• Chloramphenicol
• Oxacillin
• Metronidazole (Flagyl)
• Gentamicin
• Cefotaxime (Claforan)

85. Antivirals
• Acyclovir (Zovirax)
• Zidovudine (Retrovir)
Antifungals
• Fluconazole (Diflucan)
• Amphotericin B (AmBisome)

86. SURGICAL
• Surgeries may done accourding to the patient
condition and the diagnosis surgeries like VP
shunting.
PROGNOSIS
• Almost 25-30 % neonates die in case of
neonatal sepsis.
• Surgical procedure adversely affect the
prognosis

87. NURSING MANAGEMENT OF NEONATAL
INFECTION
• Organism can be carried to neonates on the
hands or under the nails or jewelry of
caregiver,
• No one with a skin or other infection should
enter the nursery or the rooms occupied by
the mothers.

88. • A mother who become infected should be
isolated and, if there is any question of
contamination, her neonate should be
isolated from other infants in the nursery.

89. • Culture are done
• All infants whose cultures are positive,
whether ill or not, must be isolated
• Appropriate supportive antibiotic therapy is
given to the ill infants.

90. • After all neonates have been discharge from the
contaminated nursery, the room and its contents
must be thoroughly cleaned. Contaminated
equipment should be washed and sterilized
• The parents should have an opportunity to share
their feelings concerning the infection of their
neonates

91. NURSING DIAGNOSIS OF NEONATAL
INFECTION
1) High risk for neonatal infection
2) ineffective breathing patterns
3) altered growth and development
4) Altered nutrition less than body
requirements
5) Impaired skin integrity
6) Knowledge deficit

92. PREVENTION OF NEONATAL
INFECTION
• Strict aseptic management of institutional
delivery.
• Five clean practices in home delivery- clean
surface, clean hand, clean cord tie, clean blade
and clean care stump.

93. • Hand washing before and after
the handling the baby.
• Use of sterile gown before
entering the baby care unit/
neonatal nursery and changing
the shoes.

94. • Minimum handling the newborn baby.
• Exclusion of the infected persons or carriers
from the neonatal care area.
• Maintenances of cleanliness of the
environment, that is delivery room, neonatal
care unit, postnatal area and separate area for
mother and baby at home.

95. • Use of separate and disposable belonging for each
baby, e.g., clothing, feeding, equipment, etc.
• Aseptic cleaning of baby-cot, incubator, warmer,
phototherapy machine, weighing machine , etc.
• Strict asepsis for all invasive procedure.
• Maintenance of general cleanliness of baby and
mother. Teaching the mother to maintain the hygienic
measures.

96. • Separate accommodation of the infected baby
and outside confined baby.
• Avoid unnecessary IV fluid infections needle
pricks and no sharing of needles and syringes.
• Visitors to be restricted in postnatal ward.
• Any baby showing features, suggestive of
infections should be isolated immediately.

97. • Encoring exclusive breast feeding and no
prelacteal feeding . Strict aseptic measures for
expressed breast milk feeding or artificial
feeding.
• Prevention and treatment of maternal
infection in antenatal and postnatal period.
Active immunization to the mother.

98. Prophylactic antibiotic therapy to be given, if any three of the
following factor are present, considering the baby is infected (
presumed early sepsis ) and should be treated with antibiotics (
ampicillin and gentamycin ) immediately after birth .
a) preterm baby less than
36 weeks or birth
weight less than 2 kg,
b) maternal feeding in
the preceding 2 weeks,
c) foul smelling liquor,
d) prolong rupture of
membrane more than
24 hours,
e) more than three vaginal
examination in labor,
f) birth asphyxia, Apgar
scoreless than 4 at 5
minute,
g) prolonged or difficult
delivery with
instrumentation

99. DIATORY MANAGEMENT FOR
NEONATAL INFECTION
• Because of gastrointestinal (GI) symptoms,
feeding intolerance, or poor feeding, it may be
necessary to give the neonate nothing by
mouth (nil per os; NPO) during the first days
of treatment.

100. • Consider parenteral nutrition to ensure that the
patient’s intake of calories, protein, minerals, and
electrolytes is adequate during this period.
• For the NEONATE whose condition is seriously
compromised, feeding may be restarted via a
nasogastric tube For most infants, breast milk is
the enteral diet recommended.