CASE PRESENTATION ON NEONATAL SEPSIS

1. CASE PRESENTATION ON
NEONATAL SEPSIS
SUBMITTED BY:
METI.BHARATH KUMAR
16DK1T0014
PHARM.D INTERNSHIP
1

2. SUBJECTIVE DATA
A 21 days old male baby brought to SNCU with complaints of dull activity,
decreased accepting of feeds and also fast breathing since yesterday.
Birth weight : 3 kgs.
Maturity : term (38 weeks)
Out born
C-section delivery
INDICATION FOR ADMISSION:
Respiratory distress, refusal to feeds
2

3. MOTHER’S INFORMATION
• Mothers age : 24 years
• Mothers weight :67 kgs
• Age at marriage : 21 years
• Consanguinity : yes
• Gravida :G2 : para : 1 :
live birth :1 : abortion : 0
• Gestation weeks : 38 weeks+5 days
PAST HISTORY :
Hypertension : no
Any previous illness : nil
Thyroid : euthyroid
Gestational diabetes: no
T.T doses: 2
Drugs : IFA prophylaxis
Hb : 10.5 g/dl
VDRL : -ve
APH : no
Amniotic fluid : adequate
HbsAg : -ve
HIV testing : Done –ve
3

4. MOTHER’S INFORMATION (DURING LABOUR)
• Antenatal steroids : no
• History of fever : nil
• Foul smelling : no
• Leaking pv : no
• PPH : no
• Amniotic fluid : clear
• Prolong rupture of membranes :
no
4

5. BABY INFORMATION (at birth)
At birth
• Cried immediately after birth :
no
• Weight at birth:3kgs
• Apgar at 1 min : …
• Apgar at 5 min : …
• Vitamin k given : yes
• Breast feed within 1 hour : no
General examination
• General condition : alert
• Heart rate : 142/min
• RR :65/min
• Apnea : no
• Cry : normal
• Convulsions : present on
admission
• Skin pustules :no
5

6. OBJECTIVE DATA
Day 1:
CRP = 55.4 ( mg/l)
Hb =17.8 (11.5-16.5 g/dl)
WBC : 30.2 (3.5-10*109/l)
RBC : 5.30 (4.2-5.4 cells/mcl)
Platelets: 170000 (100000-400000L/l)
6

7. Day 2
Hb =16.3 (11.5-16.5 g/dl)
WBC : 8.2(3.5-10*109/l)
RBC : 5.05 (4.2-5.4 cells/mcl)
Platelets: 102000 (100000-
400000L/l)
Day 3
Hb =15.5(11.5-16.5 g/dl)
WBC : 7.7(3.5-10*109/l)
RBC : 5.28 (4.2-5.4 cells/mcl)
Platelets: 106000 (100000-
400000L/l)
7

8. ASSESSMENT
• Based on subjective and objective data the case is confirmed as
neonatal sepsis.
8

9. TREATMENT ADVISED ON ADMISSION
• 1.warm care
• 2.O2 inhalation CPAP (continuous positive airway pressure)
• 3.IVF 10%D 60ml/kg/day
60 ml+4 cc calcium gluconate IV TID
• 4.RBS Q 8 H
• 5.inj. taxim 100mg/kg/dose
150mg IV BD
• 6.inj.phenobarbitone 20mg/kg/dose 60mg+10 cc NS = 5
mg/kg/day
9

10. DAY 2
Monitor Vitals
• Cry and activity moderate
• Peripheries warm and pink
• Passing urine and stools
• Accepting spoon feeds
• Mild RD+
• PR :136 bpm
• RR :61/min
• CRT<3sec
• CNS :AF flat tone normal
Treatment
• 1.warm care
• 2.O2 inhalation CPAP (continuous positive
airway pressure)
• 3.IVF 10%D 60ml/kg/day
60 ml+4 cc calcium gluconate IV
TID
• 4.RBS Q 8 H
• 5.inj. taxim 100mg/kg/dose
150mg IV BD
• 6.inj.phenobarbitone 20mg/kg/dose
60mg+10 cc NS = 5 mg/kg/day
10

11. DAY 3
Monitor vitals
• Cry and activity moderate
• Peripheries warm and pink
• Passing urine and stools
• Accepting spoon feeds
• Mild RD+
• PR :118 bpm
• RR :42/min
• CRT<3sec
• CNS :AF flat tone normal
Treatment
• 1.warm care
• 2.O2 inhalation CPAP (continuous positive
airway pressure)
• 3.IVF 10%D 60ml/kg/day
60 ml+4 cc calcium gluconate IV
TID
• 4.RBS Q 8 H
• 5.inj. taxim 100mg/kg/dose
150mg IV BD
• 6.inj.phenobarbitone 20mg/kg/dose
60mg+10 cc NS = 5 mg/kg/day
11

12. DAY 4
Monitor vitals
• Cry and activity moderate
• Peripheries warm and pink
• Passing urine and stools
• Accepting spoon feeds
• Mild RD+
• PR :118 bpm
• RR :63/min
• CRT<3sec
• CNS :AF flat tone normal
Treatment
• 1.warm care
• 2.O2 inhalation with nasal prongs
@2l/min
• 3.inj.phenobarbitone 5mg/kg/day
7.5mg+10 cc NS IV BD *10 min
• 4.RBS Q 8 H
• 5.inj.cefotaxime150mg IV BD
• 6.ivf isolyte p 90ml/kg/day
80 mlIV TID + 4 cc cal glu in each
drip
12

13. DAY 5
Monitor vitals
• Cry and activity moderate
• Peripheries warm and pink
• Passing urine and stools
• Accepting spoon feeds
• Mild RD+
• PR :132bpm
• RR :42/min
• CRT<3sec
• CNS :AF flat tone normal
Treatment
• 1.warm care
• 2.O2 inhalation SOS
• 3.IVF isolyte p 105 ml/kg/day
• 4.RBS Q 8 H
• 5.inj. taxim 100mg/kg/dose
150mg IV BD
• 6.inj.phenobarbitone 5mg/kg/day
• 7.spf 10 ml/kg/day
30ml /day - 4ml 3 rd hourly
13

14. DAY 6
Monitor vitals
• Cry and activity moderate
• Peripheries warm and pink
• Passing urine and stools
• Accepting spoon feeds
• Mild RD+
• PR :140 bpm
• RR :46/min
• CRT<3sec
• CNS :AF flat tone normal
Treatment
• 1.warm care
• 2. BF 2 hourly
• 3.RBS Q 8 H
• 4.inj. taxim 100mg/kg/dose
150mg IV BD
• 5.inj.phenobarbitone 7.5mg +10 cc
NS * 10 min BD
14

15. DAY 7
Monitor vitals
• Cry and activity moderate
• Peripheries warm and pink
• Passing urine and stools
• Accepting spoon feeds
• Mild RD+
• PR :120bpm
• RR :49/min
• CRT<3sec
• CNS :AF flat tone normal
Treatment
• 1.warm care
• 2.inj.cefotxime 150 mg IV BD
• 3.Syp .phenobarbtone 1 ml= 4mg
• 4.BF 2 nd hourly F/B burping
• 5. RBS Q 8 H
• 6.W/F seizures
15

16. DAY 8
Monitor vitals
• Cry and activity moderate
• Peripheries warm and pink
• Passing urine and stools
• Accepting spoon feeds
• Mild RD+
• PR :132 bpm
• RR :51/min
• CRT<3sec
• CNS :AF flat tone normal
Treatment
• 1.warm care
• 2.inj.cefotaxime 150mg IV BD
• 3.syp phenobarbitone 1ml= 4 mg
• 4.RBS Q 8 H
• 5.w/f seizures
16

17. DISCUSSION
NEONATAL SEPSIS:
Neonatal sepsis is a type of neonatal infection and specifically refers
to the presence in a newborn baby of a bacterial blood stream
infection (BSI).
It causes other systemic infections such as
(meningitis, pneumonia, pyelonephritis, or gastroenteritis).
Neonatal sepsis is divided into two categories: early-onset sepsis
(EOS) and late-onset sepsis (LOS). EOS refers to sepsis presenting
in the first 7 days of life (although some refer to EOS as within the
first 72 hours of life), with LOS referring to presentation of sepsis
after 7 days (or 72 hours, depending on the system used). Neonatal
sepsis is the single most common cause of neonatal death in
hospital as well as community in developing country.
17

18. SIGNS AND SYMPTOMS
The signs of sepsis are non-
specific and include:[1]
Body temperature changes
Breathing problems
Diarrhea
Low blood sugar
(hypoglycemia)
Reduced movements
Reduced sucking
Seizures
Bradycardia
Swollen belly area
Vomiting
Yellow skin and whites of the
eyes (jaundice).
hemorrhagic rash
A heart rate above 160 can also
be an indicator of sepsis, this
tachycardia can present up to
24 hours before the onset of
other signs.
18

19. CAUSES
• The disease can be classified as: congenital, early-onset, and late-
onset.
• Congenital neonatal sepsis is when the child is infected during
pregnancy i.e. before birth. The baby can be infected by virus
through placenta or birth canal. HIV (Human Immunodeficiency
Virus), syphilis are some of the viruses that can infect the child
before delivery.
• EOS : The early onset sepsis can caused by Group B streptococcus
(GBS) and Escherichia coli (E. coli).
• LOS : The late onset sepsis can caused by the due to After getting
discharged from hospital, babies can get infected due to the bacteria
present in the environment at home. GBS and E. coli are also
responsible for late-onset neonatal sepsis.
19

20. RISK FACTORS
Risk factors of early-onset neonatal sepsis:
frequent vaginal checkups during pregnancy
Premature birth
Infected placenta
GSB infection to the mother during pregnancy
Risk factors of late-onset neonatal sepsis:
Infected hospital environment
Staying in hospital for a long period of time
20

21. DIAGNOSIS
• Physical examination of the baby and the laboratory tests help
to diagnose the infection.
• The physical examination include, assessing the body
temperature, heart rate, breathing, etc.
• The laboratory tests aim at finding out the bacteria/virus that
has caused the infection.
• Blood tests that are performed on the infant, consist of WBC
count, platelet count, blood culture, etc. Chest X-rays and urine
tests are performed, when infection due to bacteria is
suspected.
21

22. TREATMENT
22

23. In born patients :
Ampicillin and gentamicin
Out born patients:
Cefotaxime and amikacin
• metronidazole : 15 mg/kg/day in 6 cc
iv 8th hourly
• Ceftriaxone : 50 mg/kg/day IV Q 12-24
hours.
• Cefixime : 8 mg/kg/day OD
• Cefotaxime : 100 mg/kg/day Q 8
hours
• Gentamicin : 5.0-7.5 mg/kg/day Q 8
hours
• Ampicillin : 100-200 mg/kg/day Q 6
hours
• Amikacin : 15-20 mg/kg/day Q 8 hours
• Meropenem : 20 mg/kg/dose
in CNS 40 mg/kg/dose Q 8
hours
• Vancomycin : 15 mg/kg/dose
in CNS 20 mg/kg/dose Q 6
hours
23

24. 24