infeksi pada bayi baru lahir

1. Reproductive System
Perinatology Division, Child Heath Department,
Medical Faculty of Hasanuddin University

2. Infection in neonate
 According to timing of transmission:
 Congenital Infection
 Neonatal infection
 According to severity:
 Mild infection
 Severe infection  Neonatal Sepsis

3. Timing of
transmission
NEONATAL INFECTIONCONGENITAL INFECTION
Route of
infection
Time of
presentation Month or years
later
First few weeks of
life:
-Early onset : <72 h
-Late onset : > 72 h
At birth or
month/year later
Transplacental / birth canal /
breastmilk
Transplacental
Shortly before or at delivery or
post natally
In- utero
Viral Others
CMV
Rubella
Parvovirus
VZV
Toxoplasmosis
Syphilis
Malaria
TB
Bacterial Viral Fungal
- Grouo B
streptococcus
- Gram (-) organism
- Listeria
monocytogenes
- Coagulase negative
Staph. Aureus
- Chlamidia
- Gonococcus
HSV
VZV
Enterovir
us
HIV
Hepatitis B
Hepatitis C
HPV
HTLV-1

4. Congenital
Infection
 May precipitate abortion, stillbirth or preterm delivery
 Head :
 Intracerebral calcification
 Hydrocephalus
 Microcephalus
 Eye:
 Cataracts
 Microphthalmia
 Retinitis
 Ear : Deafness
 Heart defect: Cardiomegaly, PDA
 Pneumonitis
 Splenomegaly
 Hepatomegaly
 Jaundice
 Anemia, Neutropenia,
Thrombocytopenia
 Bone abnormalities
 Rash
 IUGR
Clinical Features

5. ANTENATAL POSTNATAL
Maternal
-History (rash, contact)
-Screening serology-seroconversion (IgG, IgM, IgA)
-Culture/PCR of lession e.g.cervical herpes, blood, urine
Fetal
-Ultrasound scanning for anomalies
-Amniocentesis for
serology/culture/PCR
Placenta
-Histologi/microscopic
-Culture/PCR
Infant
- Culture/PCR: blood, urine, CSF, stool,
nasopharyngeal aspirate, skin lesion
Diagnosis

6. Neonatal Infection
Classification:
Severe Infection  Sepsis
 Early onset Sepsis (<72 hours)
 Late Onset Sepsis (>72 hours)
Mild infection: Skin, eye, umbilical, mouth, etc

7. Timing of
transmission
NEONATAL INFECTION
Route of
infection
Time of
presentation
Month or years
later
Nosocomial
Birth canal
Transplacental
Chorioamnionitis
Birth canal
Birth canal
Nosocomial
Breastmilk
Early onset sepsis
(<72 hours)
Shortly before or at delivery or post natally
HIV
Hepatitis B
Hepatitis C
HPV
HTLV-1
Late onset sepsis
(>72 hours)
Bacterial
- Grouo B streptococcus
- Gram (-) organism
-Listeria monocytogenes
-Staphylococcus Aureus
TERM PRETERM
- Grouo B
streptococcus
-Gram (-) organisms
-Coagulase negative
Staphylococcus
(CONS)
-Gram (-) organisms
-Group B
streptococcus
-Staphylococcus
Aureus
-Enterococcus
-Fungal

8.  Infections 32%
 Asphyxia 29%
 Complications of prematurity 24%
 Congenital anomalies 10%
 Other 5%
Case fatality due to neonatal sepsis is 12 to 68% in
developing countries
Neonatal Mortality

9. Neonatal sepsis- morbidity
 Brain damage due to
meningitis, septic shock, or
hypoxemia
 Other organ damage - lung,
liver, limbs, joints

10. Early Onset Sepsis - risk factors
 Maternal chorioamnionitis
 Prolonged rupture of membranes >18 h
 Foul smelling amniotic fluid
 Handling by untrained midwife
 Maternal urinary tract infection
 Premature labor

11. Chorioamnionitis
Maternal fever during labor  38ºC
± uterine tenderness
± leucocytosis
± fetal tachycardia
High risk of neonatal sepsis

12. Late Onset Sepsis -
risk factors
 Prematurity/ LBW
 In hospital
 Invasive procedures- ventilator, IV lines, central
lines, urine catheter, chest tube
 Contact with infectious disease - doctors, nurses,
babies with infections,
 Not fed maternal breast milk
 POOR HYGIENE in NICU

13. Bacterial Pathogens Responsible for Sepsis in
Developing Countries
 Early onset sepsis
 Gram negative bacilli
 E.coli
 Klebsiella
 Enterococcus
 Group B streptococcus
 Late onset sepsis
 Gram negative bacilli
 Pseudomonas
 Klebsiella
 Staph aureus
 Coagulase negative
staphylococci

14. Diagnosis of Neonatal Sepsis
 Clinical signs and symptoms
 Laboratory tests
 culture of bacterial pathogen
 other laboratory indicators
 Radiologic

15. Clinical signs and symptoms
Clinical Signs: early signs non- specific, may be subtle
 Respiratory distress- 90%
 Apnea
 Temperature instability-  temp more common
 Decreased activity
 Irritability
 Poor feeding
 Abdominal distension
 Hypotension, shock, purpura, seizures- late signs

16. Laboratory Tests
 Cultures to identify bacterial pathogen
 blood, CSF, urine, other
 Hematological tests
 WBC count (normal 5.000 – 25.000/uL)
 Platelet count (Trombocytopenia  < 100.000/mm3)
 Erythrocyte Sedimentation Rate (ESR)
 Other tests
 C- reactive protein

17. Lumbar Puncture
 Possibility of meningitis 1-10%
 Babies with meningitis may not have specific symptoms
 15% of babies with meningitis will have negative blood
cultures

18. First line therapy
 Ampicillin 50 mg/ kg
 every 12 hours in 1st week of life
 every 8 hours from 2- 4 weeks
PLUS
 Gentamicin once daily.
 > 35 weeks gestation: 4 mg / kg every 24 hours
 30 - 34 weeks gestation:
 0 - 7 days: 4.5 mg/kg every 36 hours
 > 8 days: 4 mg/kg every 24 hours

19. Supportive Care
 Temperature support
 GI support - vomiting, ileus
 Cardiorespiratory support
 hypoxia, apnea, ARDS, shock
 Hematological support: anemia, thrombocytopenia, DIC
 Neurological support- seizures

20. Prevention of Hospitalized acquired Infection
(Nosocomial Infection)
 Hand washing
 Early feeding
 Maternal breast milk
 Decrease use of broad spectrum antibiotics
 Decreased use of invasive procedures
 Proper sterilization procedures

21. 21

22. 22
 At first  vesicle
 Purulent encounter hyperemic area
 Multiple  severe systemic infection
R/ :
Isolation + aseptic treatment
A.B : Cloxacillin 50 mg/kgBW
Incise the bulla
A.B zalp
R/ topical

23. 23
 Infection with Neisseria gonorrheae ( a gram-negative
diplococcus)  a reproductive tract infection
 transmission to the fetus/ neonate in pregnancy
Clinical presentation :
 Hyperemic
 Palpebra Edema
 Purulent secret
 Unilateral/ bilateral
  cornea  Blind

24. 24
D/ : Gram’s stain of exudate  diplococcus  gram (-)
R/ :
Isolation
Eye  Topical A.B.
Systemic A.B.

25. 25
E/ : Staphylococcus aureus
Hyperemic, edema, exudate
Severe  lig. falciforme  multiple abscess
Chronic  granulom
R/ :
 Topical : A.B
 Granuloma : nitras argenti 3%
UMBILICAL INFECTION

26. 26
Thrush patches in the baby’s mouth, lips, tongue
DD/ remain milk  easy to remove
E/ fungus : Candida albicans
If : - immunocompromize
- Using A.B. for long periode
- Using corticosteroid for long periode
diarrhea +
Parenteral infection/ sepsis
Overgrowth

Moniliasis
Oral Thrush

27. 27
D/ : sediaan hapus  mycellium + spora
R/ :
 Gentian violet 0 – 5 – 1 %
 Borax glicerin
 Nistatin solution 3 x 100.000 U/day
 Severe : amphotericin B/ Fluconazol

28. THANK YOU