2. Neonatal infections are estimated to cause about 1.6 million deaths worldwide
and 40% of all neonatal deaths due to sepsis occur in developing countries.
IAP UG Teaching slides2015‐16
Even though neonatal care has dramatically improved over the last decade, the
overall as well as gestation specific mortality due to sepsis has not changed much
due to more and more smaller babies surviving in the intensive care units.
3. Systemic bacterial infections of the newborn are
termed as neonatal sepsis and include overwhelming
infection without localization (Septicemia), or
pneumonia, meningitis, urinary tractinfection.
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DEFINITION
4. • Early onset sepsis
• Late onset sepsis
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CLASSIFICATION
5. NEONATALINFECTION BYAGE OF ONSET
Characteristics Early onset sepsis Late onsetsepsis
Age at onset Birth to <72hrs > 72 hrsof life
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Maternal
obstetric
complications
Prematurity
Common Uncommon
Frequent Varies
Manifestation M ultisystem Multisystem /
focal
6. • Predisposingfactors
• Low birthweight
• Prolonged rupture of membranes >24hrs
• Chorioamnionitis (Foul smelling amnioticfluid,
Maternal fever>37.90C)
• Multiple per vaginalexamination
• Etiologic agents – organisms prevalent in maternalgenital
area.
• E.coli,Group B strepIt
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Go
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g slides 2015‐16
EARLY ONSET SEPSIS
7. • Predisposing factors
• Prolonged NICUstay
• Disruption of skin integrity with needle pricks and use
of IVfluids.
• Frequent use of broad spectrumantibiotics.
• Etiologic agents – organisms thriving in external
environments of home or hospital. Transmitted through
hands ofcare‐providers.
• Klebsiella pneumoniae
IA,
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LATE ONSET SEPSIS
8. May have either nonspecificsigns and symptoms (e.g.
not doing well, not accepting feeds) or focal signs of
infection involving one system (abdominal distension)
or it may be acute catastrophic deterioration with
multi‐organ dysfunction.
Various criteria have been devised to identify sepsis
which are shown in the next slide
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CLINICAL MANIFESTATIONS
9. X
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IMNCI
X
X
x
WHO
X( not able sustainsuch)
‐
‐
Not able tofeed
Not attaching tobreast
Not sucking atall
Pus draining fromear
Redness aroundumbilicus
extending to theskin
Reducedmovements
X
x
‐
‐
x X( change inactivity)
Lethargy or unconsciousness x X(not aroused byminimal
stimulus)
X
Convulsions x
Bulging fontanel ‐
CLINICAL CRITERIA FOR DIAGNOSISOF SEPSIS
X:Means Presence
10. IMNCI WHO
Respiratory rate>60/min x X(divided byage
group)
Severe chest indrawing x x
Nasal flaring x ‐
Grunting x ‐
Crepitations ‐ x
Cyanosis ‐ x
Temperature >37.70c (feels
hot) or <35.50c (feelscold)
x x
X:Means Presence
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CLINICAL CRITERIA FOR DIAGNOSISOF SEPSIS
12. Gold standard remains isolation of organism from body
fluids ( blood or urine orCSF).
In cases of suspected sepsis following sepsis screen
should be done and antibiotics should be started
immediately after collecting blood culturesample.
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DIAGNOSIS
15. • Positive sepsis screen ‐ 2 or more positive tests as given below.
• TLC( < 5,000 or >20,000/cu.mm),
• Neutropenia‐ Absolute neutrophil count(<1800/cu.mm)
• Immature neutrophil (band cells) to total neutrophil (I/T)
ratio > 0.2
• C‐reactive proteins‐ positive
• Micro ESR‐ (ESR > 15mm at 1st hr
.)
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INVESTIGATIONS (CONT..)
16. Late onset sepsis‐ all aboveplus
• CSF‐ biochemistry, gram stain,culture
• Urine‐ microscopy,culture
Following investigations should be done if other
systemic involvement is noted e.g. X ray abdomen.
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INVESTIGATIONS (CONT..)
17. TREATMENT – SUPPORTIVE CARE
Pr o v i d e warmth, ensure consistently
n
o
r
m
a
ltemperature
Pr o v i d e bag and mask ventilation with
oxygenif breathing is inadequate
S t a r t oxygen by hood or mask, if cyanosed or g
r
u
n
t
i
n
g
Pr o v i d e gentle physical stimulation, if apneic.
S t a r t intravenous line
Infuse glucose (10%)
IA
2
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/
ac
k
hin
g
g sli
s
de
t
s
a
20
t
15‐1
(6
if hypoglycemic)
18. TREATMENT –SUPPORTIVE CARE
IAP UG Teaching slides2015‐16
I f perfusion is poor as evidenced by capillary r
e
f
i
l
l
time (CRT) of more than 3 seconds, manage shock.
I n j . Vitamin K 1mg IM
C o n s i d e r use ofd
o
p
a
m
i
n
e
if perfusion is persistently
poor.
A v o i d enteral feed if very sick, give maintenance
fluid intravenously.
19. Antibiotic therapy forsepsis
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Antibiotic Each dose Frequency Route
mg/kg/dose <7days >7 days
Ampicillin 50 12 hrly 8 hrly IV
Gentamycin 5 24hrly 24hrly IV
ANTI‐MICROBIALS
20. Antibiotic Each dose Frequency Route
mg/kg/dose <7days >7 days
Cefotaxim 50 12 hrly 8 hrly IV
Gentamycin 5 24hrly 24hrly IV
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ANTI‐MICROBIALS (CONT..)
21. DURATION OFANTIBIOTICS
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If not improving in 2‐3 days the antibiotic treatment may
need to be changed, preferably as per microbial culture
reports.
Blood culture negative sepsis‐7 to 10 days
Blood culture positive sepsis‐10 to 14 days
Meningitis ‐21days.
22. • IVIG
• Colony stimulatingfactor
• Exchange transfusion
All these modalities need furtherstudies.
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RECENT ADVANCES
24. MASTITIS NEONATORUM
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Term baby, bothsexes
• Engorgement of breast due to effect of transplacentally
transferred progesterone andestrogens.
• This hypertrophy disappears spontaneously but local
massage and fomentation and temptation to express milk
leads to abscessformation
• Treatment with parenteral antibiotics andsurgical
drainage.
26. • Seen over scalp, neck, axillae andgroin.
• Caused by staphylococci.
• Can be punctured with sterile needle and clean with
spirit /betadine.
• Treatment with local application ofantibiotics.
• If increasing in size and number then oral antibiotics
e.g. cloxacillin
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PUSTULES
28. ORALTHRUSH
C a u s e d by Candida albicans
W h i t e patches with e
r
y
t
h
e
m
a
t
o
u
s
margins distributed over the tongue and buccal
mucosa.
U n l i k e milk curds, patches of thrush are adherent
a
n
dthey often bleed when attempts are made to
remove.
Treatment – local application of gentian violet
or nystatin or clotriamazole after eachfeed.
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30. UMBILICAL SEPSIS
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• Caused by usual skinflora i.e.staphylococci.
• Redness and edema at the base of the cord and a foul
smelling purulentdischarge.
• presence of mucoid discharge on the stump and even
isolation of bacteria are not indicative of umbilical sepsis
unless there is clinical evidence of periumbilical
inflammation or there are pus cells in the exudate.
• Treat with local application ofantibiotics
• With evidence of systemic spread‐ parenteral antibiotics.
31. CONJUNCTIVITIS
• Gonococcal conjunctivitis less commonly seen.
• Usually caused by organisms present in maternal
flora or chlamydia.
• Purulent conjunctivitis can be treated with
Neosporin or chloramphenicol ophthalmicdrops
• Eye cleaning withwater
• Nasolacrimal ductmassage
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32. • Good antenatal, intranatal and postnatalcare
• Clean attendant’s hand ( washed withsoap)
• Clean delivery surface
• Clean cord cutting instrument (i.e. razor,blade)
• Clean string to tiecords
• Clean cloth to wrap thebaby
• Clean cloth to wrap themother
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PREVENTION
33. • Prevent overcrowding
• Ensure earlybreastfeeding
• Hand washing
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PREVENTION (CONT..)
34. PREVENTION – HAND WASH
Before touching any baby‐
• Sleeves should be rolled above the elbows. Rings,
watches and jewellery should beremoved.
• 1st hand wash‐ up to elbows with a thorough scrub for
2 minutes, all areas including the under surface of well
trimmed nails.
• In between patients hand wash for 20 seconds up to
elbows.
IAP UG Teaching slides2015‐16
