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Neonatal Sepsis
Malar Kodi. S
Assistant Professor
AIIMS, Rishikesh
1
2
Neonatal sepsis
Clinical syndrome of bacteremia with
systemic signs and symptoms of infection
in the first four weeks of life
3
Neonatal sepsis
COMMONEST CAUSE OF NEONATAL
DEAHS
4
Common organisms
Klebsiella pneumoniae
E. coli
Staphylococcus aureus
Pseudomonas
Early vs Late onset sepsis
Early Late
Onset Upto 72 hrs After 72 hrs
Source Maternal Postnatal
environment
Presentation Fulminant
multisystem
Pneumonia
frequent
Slowly
progressive,focal
Meningitis
frequent
Mortality 15-50% 10-20%
6
Symptoms of neonatal sepsis
 CNS
 Lethargy, refusal to suckle, limp, not arousable,
poor or high pitched cry, irritable, seizures
 CVS
 Pallor, cyanosis, cold clammy skin
 Respiratory
 Tachypnea, apnea, grunt, retractions
Teaching Aids: NNF NS- 7
Symptoms of neonatal sepsis
 GIT
 Vomiting, diarrhea, abdominal distension
 Hematological
 Bleeding, jaundice
 Skin
 Rashes, purpura, pustules
8
Signs of neonatal sepsis
 Cold to touch ( hypothermia )
 Poor perfusion ( CRT )
 Hypotension
 Renal failure
 Sclerema
 Bulging fontanels, neck retraction
 Poor weight gain*
* Indicates low grade sepsis
Clinical features of severe
infections
WHO Young Infant study
1. Feeding ability
reduced
2. No spontaneous
movement
3. Temperature >380 C
4. Prolonged capillary
refill time
5. Lower chest wall
indrawing
6. Resp. rate >
60/minute
7. Grunting
8. Cyanosis
9. H/o of convulsions
Diagnosis of neonatal
sepsis
Direct
- Isolation of organisms from blood, CSF,
urine is diagnostic
Indirect
-Screening tests
Sepsis screen
Leukopenia (TLC < 5000mm3)
Neutropenia (ANC < 1800/mm3)
Immature neutrophil to total neutrophil
(I/T) ratio (> 0.2)
Micro-ESR (> 15mm 1st hour)
CRP +ve*
*If two or more tests are positive treat infant as neonatal sepsis
NS-
Mature neutrophil Band cell
Neutrophils
Meningitis
10-15 percent cases of sepsis have
meningitis
Meningitis can be often missed clinically
LP must be done in all cases of late onset
& symptomatic early onset sepsis
• For babies with neonatal
sepsis,
15
Management: Supportive care
o Keep the neonate warm
o If sick, avoid enteral feed
o Start IV fluids, infuse 10% dextrose- 2 ml/kg
over 2-3 minutes to maintain normoglycemia
o Maintain fluid and electrolyte balance and
tissue perfusion. If CRT >3 sec, infuse 10 ml/kg
normal saline
16
Supportive care
 Start oxygen by hood, if cyanosed or
having RR >60/min or severe chest
retractions
 Consider exchange blood transfusion, if
there is sclerema
Choice of antibiotics
Pneumonia or Sepsis
Penicillin Aminoglycoside
(Ampicillin or Cloxacillin) (Gentamicin or Amikacin)
Meningitis
Ampicillin + Gentamicin
Or
Gentamicin o Amikacin + Cefotaxime
+
Cont…Antibiotic therapy
In Septicemia and Pneumonia
• Injection Ampicillin 50 mg/kg/dose 12 hourly IV
or IM 7 to 10 days
• Injection Gentamicin 2.5mg/kg/dose BD IV/IM, 7
to 10 days
In Meningitis
• Injection Ampicillin 100 mg/kg/dose 12 hourly IV
3 weeks
• Injection Gentamicin 2.5mg/kg/dose BD IV,
3Weeks or
• Injection Chloramphenicol 12mg/kg/dose BD
IV, 3weeks
Suspected neonatal sepsis
√ Start parenteral antibiotics
√ Send cultures (report in 72 hrs)
Culture -ve Culture +ve
Clinically not
sepsis (Stop Ab)
Clinically ill
(Cont Abx7-10D)
Pneumonia, Sepsis
(Cont Ab X 7-10D)
Meningitis, Osteomyelitis
(Cont Ab X 3-6 wks)
Superficial infections
o Pustules - After puncturing, clean
with betadine and apply
local antimicrobial
o Conjunctivitis - Chloramphenicol eye
drops
o Oral thrush - Local application of
nystatin or Clotrimazole
21
Prevention of infections
 Exclusive breastfeeding
 Keep cord dry
 Hand washing by care givers
 Hygiene of baby
 No unnecessary interventions
Teaching Aids: NNF NS-22
A scanned picture of steps of hand
washing
Six steps of hand washing
Step 1
Wash palms with fingers
Step 2
Wash back of hands
Step 3
Wash fingers & knuckles
Step 5
Wash finger tips
Step 6
Wash wrists
Step 4
Wash thumbs
Hand washing
o Simplest, most effective measure for preventing
hospital acquired infections
o 2 minutes hand washing prior to entering
nursery
o 15 seconds of hand washing before touching baby
o Alcohol based hand rub effective but costly
24
Control of hospital
infections
Hand washing by all staff
Isolation of infectious patient
Use plenty of disposable items
Avoid overcrowding
Aseptic work culture
Infection surveillance
Teaching Aids: NNF NS-25
Work culture
o Sterile gowns and linen for babies
o Hand washing by all
o Regular cleaning of unit
o No sharing of baby belongings
o Dispose waste-products in separate bins
Control of hospital outbreak
of infections
 Epidemiological investigation
 Increased emphasis on hand washing
 Reinforce all preventive measures
 Review of protocols of nursery
 Screen all personnel
 Review of antibiotic policy
 Cohorting of infants
Conclusion
 High index of clinical suspicion
 Look for lab evidence of sepsis
 Start parenteral antibiotics (I.V.)
 Ampicillin + Aminoglycoside
 Provide supportive care
 Review culture reports
 Practice barrier nursing to prevent cross-
infection

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Neonatal sepsis.pptx

  • 1. Neonatal Sepsis Malar Kodi. S Assistant Professor AIIMS, Rishikesh 1
  • 2. 2 Neonatal sepsis Clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first four weeks of life
  • 4. 4 Common organisms Klebsiella pneumoniae E. coli Staphylococcus aureus Pseudomonas
  • 5. Early vs Late onset sepsis Early Late Onset Upto 72 hrs After 72 hrs Source Maternal Postnatal environment Presentation Fulminant multisystem Pneumonia frequent Slowly progressive,focal Meningitis frequent Mortality 15-50% 10-20%
  • 6. 6 Symptoms of neonatal sepsis  CNS  Lethargy, refusal to suckle, limp, not arousable, poor or high pitched cry, irritable, seizures  CVS  Pallor, cyanosis, cold clammy skin  Respiratory  Tachypnea, apnea, grunt, retractions
  • 7. Teaching Aids: NNF NS- 7 Symptoms of neonatal sepsis  GIT  Vomiting, diarrhea, abdominal distension  Hematological  Bleeding, jaundice  Skin  Rashes, purpura, pustules
  • 8. 8 Signs of neonatal sepsis  Cold to touch ( hypothermia )  Poor perfusion ( CRT )  Hypotension  Renal failure  Sclerema  Bulging fontanels, neck retraction  Poor weight gain* * Indicates low grade sepsis
  • 9. Clinical features of severe infections WHO Young Infant study 1. Feeding ability reduced 2. No spontaneous movement 3. Temperature >380 C 4. Prolonged capillary refill time 5. Lower chest wall indrawing 6. Resp. rate > 60/minute 7. Grunting 8. Cyanosis 9. H/o of convulsions
  • 10. Diagnosis of neonatal sepsis Direct - Isolation of organisms from blood, CSF, urine is diagnostic Indirect -Screening tests
  • 11. Sepsis screen Leukopenia (TLC < 5000mm3) Neutropenia (ANC < 1800/mm3) Immature neutrophil to total neutrophil (I/T) ratio (> 0.2) Micro-ESR (> 15mm 1st hour) CRP +ve* *If two or more tests are positive treat infant as neonatal sepsis
  • 12. NS- Mature neutrophil Band cell Neutrophils
  • 13. Meningitis 10-15 percent cases of sepsis have meningitis Meningitis can be often missed clinically LP must be done in all cases of late onset & symptomatic early onset sepsis
  • 14. • For babies with neonatal sepsis,
  • 15. 15 Management: Supportive care o Keep the neonate warm o If sick, avoid enteral feed o Start IV fluids, infuse 10% dextrose- 2 ml/kg over 2-3 minutes to maintain normoglycemia o Maintain fluid and electrolyte balance and tissue perfusion. If CRT >3 sec, infuse 10 ml/kg normal saline
  • 16. 16 Supportive care  Start oxygen by hood, if cyanosed or having RR >60/min or severe chest retractions  Consider exchange blood transfusion, if there is sclerema
  • 17. Choice of antibiotics Pneumonia or Sepsis Penicillin Aminoglycoside (Ampicillin or Cloxacillin) (Gentamicin or Amikacin) Meningitis Ampicillin + Gentamicin Or Gentamicin o Amikacin + Cefotaxime +
  • 18. Cont…Antibiotic therapy In Septicemia and Pneumonia • Injection Ampicillin 50 mg/kg/dose 12 hourly IV or IM 7 to 10 days • Injection Gentamicin 2.5mg/kg/dose BD IV/IM, 7 to 10 days In Meningitis • Injection Ampicillin 100 mg/kg/dose 12 hourly IV 3 weeks • Injection Gentamicin 2.5mg/kg/dose BD IV, 3Weeks or • Injection Chloramphenicol 12mg/kg/dose BD IV, 3weeks
  • 19. Suspected neonatal sepsis √ Start parenteral antibiotics √ Send cultures (report in 72 hrs) Culture -ve Culture +ve Clinically not sepsis (Stop Ab) Clinically ill (Cont Abx7-10D) Pneumonia, Sepsis (Cont Ab X 7-10D) Meningitis, Osteomyelitis (Cont Ab X 3-6 wks)
  • 20. Superficial infections o Pustules - After puncturing, clean with betadine and apply local antimicrobial o Conjunctivitis - Chloramphenicol eye drops o Oral thrush - Local application of nystatin or Clotrimazole
  • 21. 21 Prevention of infections  Exclusive breastfeeding  Keep cord dry  Hand washing by care givers  Hygiene of baby  No unnecessary interventions
  • 22. Teaching Aids: NNF NS-22 A scanned picture of steps of hand washing Six steps of hand washing Step 1 Wash palms with fingers Step 2 Wash back of hands Step 3 Wash fingers & knuckles Step 5 Wash finger tips Step 6 Wash wrists Step 4 Wash thumbs
  • 23. Hand washing o Simplest, most effective measure for preventing hospital acquired infections o 2 minutes hand washing prior to entering nursery o 15 seconds of hand washing before touching baby o Alcohol based hand rub effective but costly
  • 24. 24 Control of hospital infections Hand washing by all staff Isolation of infectious patient Use plenty of disposable items Avoid overcrowding Aseptic work culture Infection surveillance
  • 25. Teaching Aids: NNF NS-25 Work culture o Sterile gowns and linen for babies o Hand washing by all o Regular cleaning of unit o No sharing of baby belongings o Dispose waste-products in separate bins
  • 26. Control of hospital outbreak of infections  Epidemiological investigation  Increased emphasis on hand washing  Reinforce all preventive measures  Review of protocols of nursery  Screen all personnel  Review of antibiotic policy  Cohorting of infants
  • 27. Conclusion  High index of clinical suspicion  Look for lab evidence of sepsis  Start parenteral antibiotics (I.V.)  Ampicillin + Aminoglycoside  Provide supportive care  Review culture reports  Practice barrier nursing to prevent cross- infection