Neonatal sepsis is an infection that occurs in the first month of life. It can involve the bloodstream (sepsis), lungs (pneumonia), or brain (meningitis). Risk factors include preterm birth, rupture of membranes over 18 hours before delivery, and maternal infection. Symptoms may include poor feeding, temperature instability, respiratory distress, and lethargy. Diagnosis involves blood, CSF, and culture tests. Treatment requires antibiotics, respiratory support, and care of other organ systems until the infant recovers. Preventing infection in both mother and baby is important to reduce the risk of neonatal sepsis.
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
This document discusses neonatal sepsis and its prevention. It defines neonatal sepsis as infection in infants under 4 weeks old shown through systemic signs. Common causes are E. coli, GBS, and other bacteria. Sepsis can be early onset from maternal exposure or late onset from hospital exposure. Prevention focuses on good antenatal care, infection control in neonatal units like handwashing, and minimizing invasive procedures and equipment sharing between infants. Proper feeding, skin care, and environmental cleaning practices can also help prevent neonatal sepsis.
Bacterial infection in Newborns.Neonatal sepsisEneutron
Neonatal sepsis is a clinical syndrome of systemic infection occurring in the first month of life. It can be caused by a variety of bacterial, viral, and fungal pathogens. Clinical signs are non-specific but may include temperature irregularity, feeding problems, respiratory distress, and cardiovascular or neurological abnormalities. Diagnosis involves blood, urine, CSF and other cultures along with complete blood count and other labs to identify infection and inflammation. Treatment involves empiric broad-spectrum antibiotics tailored to the infant's age and infection risk along with supportive care of affected organ systems. Factors like prematurity, chorioamnionitis, and invasive procedures increase sepsis risk in newborns.
This document discusses neonatal sepsis, including definitions, risk factors, evaluation, treatment and prevention. It provides guidelines for:
- Empiric antibiotic treatment of common organisms like GBS and E. coli based on susceptibility patterns. For GBS, penicillin is recommended. For ampicillin-sensitive E. coli, ampicillin or cefotaxime can be used.
- Duration of treatment based on culture results and clinical response. Treatment is typically 10-14 days for positive cultures and 48 hours for negative cultures if the infant is improving.
- Changing or extending treatment if meningitis is suspected or the infant is not improving on current regimens. Serial monitoring of markers like CRP is advised to
Neonatal sepsis is a clinical syndrome of bacteremia and infection in infants under 4 weeks of age. Common causes are E. coli, Group B Streptococcus, and Listeria. It can be early-onset from transmission during birth or late-onset from hospital-acquired infections. Symptoms are non-specific but include respiratory distress, feeding issues, and temperature instability. Diagnosis involves blood, urine and CSF cultures. Treatment is antibiotics like ampicillin and gentamicin for 10-14 days along with supportive care. Prevention includes good antenatal care, treating maternal infections, early breastfeeding and infection control policies in the NICU.
This document discusses pneumonia in children. It provides definitions, epidemiology, risk factors, classification, etiology, clinical presentation, investigations, treatment and prevention of pneumonia. Some key points:
- Pneumonia is the leading cause of death among children under 5 globally, accounting for 16% of deaths. It occurs most frequently in developing countries.
- Risk factors include malnutrition, low birth weight, lack of breastfeeding, lack of immunization, indoor air pollution, parental smoking, and zinc deficiency.
- Clinical features depend on the causative agent. Bacterial pneumonia presents with high fever and chest pain while viral pneumonia shows low grade fever and respiratory distress.
- Investigations include chest X-ray
Neonatal sepsis is a clinical syndrome of bacteraemia with systemic signs and symptoms of infection in the first four weeks of life. It is a major cause of neonatal mortality worldwide, responsible for 1.5-2 million deaths per year in developing countries. Clinical features include respiratory distress, poor feeding, and lethargy. Diagnosis involves blood, cerebrospinal fluid and other cultures. Treatment involves supportive care and antibiotics chosen based on the likely causative organisms. Prevention strategies include handwashing, isolation procedures, and intrapartum antibiotic prophylaxis for at-risk mothers.
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
This document discusses neonatal sepsis and its prevention. It defines neonatal sepsis as infection in infants under 4 weeks old shown through systemic signs. Common causes are E. coli, GBS, and other bacteria. Sepsis can be early onset from maternal exposure or late onset from hospital exposure. Prevention focuses on good antenatal care, infection control in neonatal units like handwashing, and minimizing invasive procedures and equipment sharing between infants. Proper feeding, skin care, and environmental cleaning practices can also help prevent neonatal sepsis.
Bacterial infection in Newborns.Neonatal sepsisEneutron
Neonatal sepsis is a clinical syndrome of systemic infection occurring in the first month of life. It can be caused by a variety of bacterial, viral, and fungal pathogens. Clinical signs are non-specific but may include temperature irregularity, feeding problems, respiratory distress, and cardiovascular or neurological abnormalities. Diagnosis involves blood, urine, CSF and other cultures along with complete blood count and other labs to identify infection and inflammation. Treatment involves empiric broad-spectrum antibiotics tailored to the infant's age and infection risk along with supportive care of affected organ systems. Factors like prematurity, chorioamnionitis, and invasive procedures increase sepsis risk in newborns.
This document discusses neonatal sepsis, including definitions, risk factors, evaluation, treatment and prevention. It provides guidelines for:
- Empiric antibiotic treatment of common organisms like GBS and E. coli based on susceptibility patterns. For GBS, penicillin is recommended. For ampicillin-sensitive E. coli, ampicillin or cefotaxime can be used.
- Duration of treatment based on culture results and clinical response. Treatment is typically 10-14 days for positive cultures and 48 hours for negative cultures if the infant is improving.
- Changing or extending treatment if meningitis is suspected or the infant is not improving on current regimens. Serial monitoring of markers like CRP is advised to
Neonatal sepsis is a clinical syndrome of bacteremia and infection in infants under 4 weeks of age. Common causes are E. coli, Group B Streptococcus, and Listeria. It can be early-onset from transmission during birth or late-onset from hospital-acquired infections. Symptoms are non-specific but include respiratory distress, feeding issues, and temperature instability. Diagnosis involves blood, urine and CSF cultures. Treatment is antibiotics like ampicillin and gentamicin for 10-14 days along with supportive care. Prevention includes good antenatal care, treating maternal infections, early breastfeeding and infection control policies in the NICU.
This document discusses pneumonia in children. It provides definitions, epidemiology, risk factors, classification, etiology, clinical presentation, investigations, treatment and prevention of pneumonia. Some key points:
- Pneumonia is the leading cause of death among children under 5 globally, accounting for 16% of deaths. It occurs most frequently in developing countries.
- Risk factors include malnutrition, low birth weight, lack of breastfeeding, lack of immunization, indoor air pollution, parental smoking, and zinc deficiency.
- Clinical features depend on the causative agent. Bacterial pneumonia presents with high fever and chest pain while viral pneumonia shows low grade fever and respiratory distress.
- Investigations include chest X-ray
Neonatal sepsis is a clinical syndrome of bacteraemia with systemic signs and symptoms of infection in the first four weeks of life. It is a major cause of neonatal mortality worldwide, responsible for 1.5-2 million deaths per year in developing countries. Clinical features include respiratory distress, poor feeding, and lethargy. Diagnosis involves blood, cerebrospinal fluid and other cultures. Treatment involves supportive care and antibiotics chosen based on the likely causative organisms. Prevention strategies include handwashing, isolation procedures, and intrapartum antibiotic prophylaxis for at-risk mothers.
This document provides information about neonatal sepsis for nursing students. It defines neonatal sepsis as a clinical syndrome of bacteremia with systemic signs and symptoms occurring in the first 4 weeks of life. It states that neonatal sepsis accounts for 15% of neonatal deaths worldwide and 47.7% of neonatal deaths in Nepal. It describes the causes, types, pathophysiology, clinical features, diagnosis, management including antibiotics, nursing care, prevention and prognosis of neonatal sepsis.
Neonatal sepsis occurs when bacteria enter the bloodstream of infants less than 90 days old. It can be early onset (within 24 hours of birth) from bacteria passed from the mother during delivery, or late onset from bacteria acquired after birth. Risk factors include preterm birth, infections, and prolonged hospitalization. Symptoms are non-specific but may include poor feeding, lethargy, respiratory distress, and temperature instability. Diagnosis involves blood, urine and CSF cultures. Treatment consists of supportive care and intravenous antibiotics like ampicillin and gentamycin. Outcomes depend on the causative organism and can include neurological and respiratory complications.
Meconium aspiration syndrome (MAS) occurs when a baby inhales or aspirates meconium during delivery. Meconium is the dark green intestinal contents produced by fetuses before birth. Factors like post-term delivery or fetal distress can cause a fetus to pass meconium into the amniotic fluid before birth. If this thick, meconium-stained fluid is then inhaled or aspirated during delivery, it can block the baby's airways and cause MAS. Treatment involves immediate suctioning and clearing of the airways after birth, as well as oxygen therapy and antibiotics if needed to treat respiratory distress and prevent infection. More severe cases may require ventilation support or other advanced treatments like
The document provides an overview of neonatal tetanus, including its history, epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, treatment, and prevention. Some key points:
- Neonatal tetanus is caused by Clostridium tetani bacteria entering the body through a wound, usually the umbilical stump of a newborn.
- It kills approximately 500,000 infants annually, mainly in developing countries.
- Symptoms include difficulty feeding, crying, stiffness, and painful muscle spasms.
- Treatment involves wound cleaning, tetanus immunoglobulin, antibiotics, muscle relaxants, and supportive care like mechanical ventilation.
- Prevention relies on
Neonatal sepsis is a clinical syndrome of systemic illness accompanied by bacteria in the blood occurring in the first month of life. It can be early-onset within the first week of life, usually acquired during birth from the mother, or late-onset between 1 week to 1 month of life, often from the hospital environment. Symptoms are non-specific but can include temperature irregularities, poor feeding, or respiratory distress. Treatment involves blood cultures, antibiotics like ampicillin and gentamicin, and supportive care for complications involving various organ systems. Future treatments may involve immunotherapies and blocking inflammatory responses.
Neonatal septicemia is a systemic bacterial infection occurring in newborns. It is a major cause of mortality, especially in developing countries and low birth weight/preterm infants. Sepsis can be classified as early onset (within 72 hours of birth) or late onset. Common clinical features include poor feeding, respiratory distress, hypothermia, and lethargy. Definitive diagnosis requires a positive culture from blood, CSF, or other sterile sites. However, cultures are often negative so diagnostic tests including complete blood count, c-reactive protein, and blood culture are also used. Early diagnosis and treatment with antibiotics is important to prevent mortality from neonatal septicemia.
Meconium aspiration syndrome is a respiratory condition in newborns who pass meconium in the amniotic fluid before delivery. It occurs when meconium is aspirated or inhaled into the lungs around birth. Risk factors include post-term pregnancy or maternal health conditions. Clinically, affected infants have respiratory distress. Management involves suctioning meconium from the airways, providing respiratory support, antibiotics, and other organ system support. Outcomes range from full recovery to complications like chronic lung disease.
The document summarizes neonatal sepsis, including its definition, epidemiology, causes, symptoms, diagnosis, and treatment. It discusses the pathophysiology of neonatal immune deficiency that predisposes infants to sepsis. Early and late onset sepsis are described, along with common pathogens for each. Risk factors like prematurity, maternal infections, and invasive procedures are outlined. The clinical presentation of sepsis is generally non-specific. Evaluation includes blood tests and cultures. Treatment involves initial broad-spectrum antibiotics tailored based on results and infant risk factors. Prevention strategies like vaccines and hand washing are mentioned.
This document discusses the infant of a diabetic mother. It begins with an introduction stating that diabetes is a common complication of pregnancy and risks to the infant have decreased but still exist. It then covers pathophysiology, epidemiology, complications, management, and prognosis. Key points include: fetal macrosomia is a risk; hypoglycemia is common due to hyperinsulinemia; other risks include hypocalcemia, hypomagnesemia, and congenital heart defects. Management involves monitoring glucose and electrolytes along with imaging tests. Treatment focuses on maintaining normal glucose during labor and delivery along with early breastfeeding to prevent hypoglycemia. Prognosis is generally good but neurodevelopmental risks exist if maternal glucose control was
This document discusses childhood asthma, including its classification, epidemiology, etiology, pathogenesis, clinical features, complications, management, prognosis, and prevention. It provides case scenarios to demonstrate the diagnosis of asthma in children. Key points include that asthma is a chronic inflammatory condition of the airways causing episodic obstruction, it has a prevalence of 20% in Pakistani children, and is diagnosed based on a history of recurrent or intermittent respiratory symptoms and signs of bronchial obstruction on examination. Asthma is managed by avoiding triggers, using quick-relief and preventive medications, and treating exacerbations.
Birth asphyxia is a combination of lack of oxygen and perfusion during birth that results in an Apgar score of 0-3 at one minute or 4-7 with associated etiology. Each year, 4 million births experience asphyxia, with 1 million infant deaths and 1 million developing serious long-term neurological issues. Causes include interrupted umbilical blood flow, premature placental separation, maternal hypotension or hypoxia, and failure to properly resuscitate. Risk factors include maternal diabetes, hypertension, bleeding, and prolonged rupture of membranes as well as fetal prematurity, anomalies, and distress during labor and delivery. Asphyxia progresses through primary apnea, gasping, and secondary apnea phases, and
This document discusses urinary tract infections (UTIs) in infants and children. Key points include:
- UTIs are common in this age group and can cause renal damage if not treated promptly.
- Diagnosis is based on a positive urine culture showing significant bacteriuria.
- Treatment involves antibiotics, with hospitalization for young infants or those with complications.
- Evaluation after a first UTI aims to identify risk factors for renal damage, through ultrasound, DMSA renal scan, and MCU.
Neonatal sepsis occurs when bacteria enter the bloodstream of infants less than 90 days old. It can cause overwhelming infection or spread to organs like the lungs (pneumonia) or meningitis. Common causes are E. coli, listeria, and certain streptococcus bacteria. Risk factors include preterm birth, maternal infection, and hospitalization after birth. Symptoms are non-specific but include temperature changes, breathing issues, poor feeding, and lethargy. Diagnosis involves blood, urine, and CSF tests and treatment is with antibiotics like ampicillin and gentamicin alongside supportive care. Outcomes can vary from full recovery to neurological or respiratory problems, especially in preterm infants.
Neonatal intensive care has evolved significantly since the 1900s due to advances in technology, care protocols, and therapeutics. Preterm birth remains a major challenge, with preemies facing immature organ systems and higher risks of complications like sepsis, respiratory distress, brain injuries, and more. The first hour after preterm birth less than 32 weeks is critical, and protocols aim to stabilize infants during this "golden hour." Despite gains, prematurity continues to cause mortality and morbidity. New technologies and the question of how to care for the smallest infants pose ongoing challenges for neonatal intensive care.
The document discusses the management of neonatal hypoglycemia. It defines hypoglycemia and lists its common causes such as excess insulin, limited glycogen storage, and decreased gluconeogenesis. It classifies hypoglycemia as transient or persistent and describes the management and treatment approaches for each type. Nursing management plays an important role in prevention, maintaining normal blood glucose levels, and treating hypoglycemic events. Untreated hypoglycemia can lead to serious complications affecting the brain and heart.
Neonatal sepsis remains a challenge, with rates varying significantly between institutions. While early-onset sepsis is usually caused by bacteria acquired before or during birth, late-onset sepsis often results from bacteria acquired after birth in the NICU. Diagnosis relies on clinical signs and laboratory tests like blood cultures and CRP levels. New diagnostic methods including PCR and microarrays show promise, but further studies are needed. Treatment requires appropriate empiric antibiotics while cultures are pending, with adjustments based on identified organisms and developing antimicrobial resistance patterns.
This document provides information on convulsions and epilepsy in children. It discusses the history of epilepsy, notable figures associated with epilepsy like St. Valentine, important epilepsy awareness days, common misconceptions about epilepsy, types of seizures including partial seizures, generalized seizures, absence seizures, and infantile spasms. It also covers the classification, causes, mechanisms, and syndromes of epilepsy as well as comparisons between different seizure types.
Pediatrics notes about "Neonatal Resuscitation". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
Neonatal apnea is the cessation of breathing for over 10-15 seconds, commonly affecting premature infants around 2-6 months old due to underdeveloped respiratory systems. There are three main types of apnea: central apnea caused by lack of breathing signal from the brain; obstructive apnea caused by weak respiratory muscles; and mixed apnea showing traits of both. Treatment of neonatal apnea in preterm infants involves close monitoring in the NICU, determining underlying causes, and administering medication depending on severity and type of apnea.
The document discusses the case of a 51-year-old man presenting with severe sepsis and septic shock. It outlines his initial treatment including IV fluids, antibiotics, and vasopressors. Further workup revealed a hepatic abscess which was drained surgically. The patient eventually recovered after 10 days of targeted antibiotic therapy guided by cultures. The document also reviews key literature on defining sepsis, early management principles like early goal-directed therapy, and optimization of oxygen delivery through fluid resuscitation, vasopressors, inotropes, and blood transfusions.
This document outlines best practices for infection prevention including describing the disease transmission cycle, key principles of infection prevention, and proper handwashing, antisepsis, use of personal protective equipment, safe handling of sharps, instrument processing, and waste disposal. It emphasizes that rigorous adherence to infection prevention practices such as handwashing, use of antiseptics and protective equipment, and safe disposal of contaminated waste and needles can significantly reduce the risk of infection for both healthcare staff and patients.
This document provides information about neonatal sepsis for nursing students. It defines neonatal sepsis as a clinical syndrome of bacteremia with systemic signs and symptoms occurring in the first 4 weeks of life. It states that neonatal sepsis accounts for 15% of neonatal deaths worldwide and 47.7% of neonatal deaths in Nepal. It describes the causes, types, pathophysiology, clinical features, diagnosis, management including antibiotics, nursing care, prevention and prognosis of neonatal sepsis.
Neonatal sepsis occurs when bacteria enter the bloodstream of infants less than 90 days old. It can be early onset (within 24 hours of birth) from bacteria passed from the mother during delivery, or late onset from bacteria acquired after birth. Risk factors include preterm birth, infections, and prolonged hospitalization. Symptoms are non-specific but may include poor feeding, lethargy, respiratory distress, and temperature instability. Diagnosis involves blood, urine and CSF cultures. Treatment consists of supportive care and intravenous antibiotics like ampicillin and gentamycin. Outcomes depend on the causative organism and can include neurological and respiratory complications.
Meconium aspiration syndrome (MAS) occurs when a baby inhales or aspirates meconium during delivery. Meconium is the dark green intestinal contents produced by fetuses before birth. Factors like post-term delivery or fetal distress can cause a fetus to pass meconium into the amniotic fluid before birth. If this thick, meconium-stained fluid is then inhaled or aspirated during delivery, it can block the baby's airways and cause MAS. Treatment involves immediate suctioning and clearing of the airways after birth, as well as oxygen therapy and antibiotics if needed to treat respiratory distress and prevent infection. More severe cases may require ventilation support or other advanced treatments like
The document provides an overview of neonatal tetanus, including its history, epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, treatment, and prevention. Some key points:
- Neonatal tetanus is caused by Clostridium tetani bacteria entering the body through a wound, usually the umbilical stump of a newborn.
- It kills approximately 500,000 infants annually, mainly in developing countries.
- Symptoms include difficulty feeding, crying, stiffness, and painful muscle spasms.
- Treatment involves wound cleaning, tetanus immunoglobulin, antibiotics, muscle relaxants, and supportive care like mechanical ventilation.
- Prevention relies on
Neonatal sepsis is a clinical syndrome of systemic illness accompanied by bacteria in the blood occurring in the first month of life. It can be early-onset within the first week of life, usually acquired during birth from the mother, or late-onset between 1 week to 1 month of life, often from the hospital environment. Symptoms are non-specific but can include temperature irregularities, poor feeding, or respiratory distress. Treatment involves blood cultures, antibiotics like ampicillin and gentamicin, and supportive care for complications involving various organ systems. Future treatments may involve immunotherapies and blocking inflammatory responses.
Neonatal septicemia is a systemic bacterial infection occurring in newborns. It is a major cause of mortality, especially in developing countries and low birth weight/preterm infants. Sepsis can be classified as early onset (within 72 hours of birth) or late onset. Common clinical features include poor feeding, respiratory distress, hypothermia, and lethargy. Definitive diagnosis requires a positive culture from blood, CSF, or other sterile sites. However, cultures are often negative so diagnostic tests including complete blood count, c-reactive protein, and blood culture are also used. Early diagnosis and treatment with antibiotics is important to prevent mortality from neonatal septicemia.
Meconium aspiration syndrome is a respiratory condition in newborns who pass meconium in the amniotic fluid before delivery. It occurs when meconium is aspirated or inhaled into the lungs around birth. Risk factors include post-term pregnancy or maternal health conditions. Clinically, affected infants have respiratory distress. Management involves suctioning meconium from the airways, providing respiratory support, antibiotics, and other organ system support. Outcomes range from full recovery to complications like chronic lung disease.
The document summarizes neonatal sepsis, including its definition, epidemiology, causes, symptoms, diagnosis, and treatment. It discusses the pathophysiology of neonatal immune deficiency that predisposes infants to sepsis. Early and late onset sepsis are described, along with common pathogens for each. Risk factors like prematurity, maternal infections, and invasive procedures are outlined. The clinical presentation of sepsis is generally non-specific. Evaluation includes blood tests and cultures. Treatment involves initial broad-spectrum antibiotics tailored based on results and infant risk factors. Prevention strategies like vaccines and hand washing are mentioned.
This document discusses the infant of a diabetic mother. It begins with an introduction stating that diabetes is a common complication of pregnancy and risks to the infant have decreased but still exist. It then covers pathophysiology, epidemiology, complications, management, and prognosis. Key points include: fetal macrosomia is a risk; hypoglycemia is common due to hyperinsulinemia; other risks include hypocalcemia, hypomagnesemia, and congenital heart defects. Management involves monitoring glucose and electrolytes along with imaging tests. Treatment focuses on maintaining normal glucose during labor and delivery along with early breastfeeding to prevent hypoglycemia. Prognosis is generally good but neurodevelopmental risks exist if maternal glucose control was
This document discusses childhood asthma, including its classification, epidemiology, etiology, pathogenesis, clinical features, complications, management, prognosis, and prevention. It provides case scenarios to demonstrate the diagnosis of asthma in children. Key points include that asthma is a chronic inflammatory condition of the airways causing episodic obstruction, it has a prevalence of 20% in Pakistani children, and is diagnosed based on a history of recurrent or intermittent respiratory symptoms and signs of bronchial obstruction on examination. Asthma is managed by avoiding triggers, using quick-relief and preventive medications, and treating exacerbations.
Birth asphyxia is a combination of lack of oxygen and perfusion during birth that results in an Apgar score of 0-3 at one minute or 4-7 with associated etiology. Each year, 4 million births experience asphyxia, with 1 million infant deaths and 1 million developing serious long-term neurological issues. Causes include interrupted umbilical blood flow, premature placental separation, maternal hypotension or hypoxia, and failure to properly resuscitate. Risk factors include maternal diabetes, hypertension, bleeding, and prolonged rupture of membranes as well as fetal prematurity, anomalies, and distress during labor and delivery. Asphyxia progresses through primary apnea, gasping, and secondary apnea phases, and
This document discusses urinary tract infections (UTIs) in infants and children. Key points include:
- UTIs are common in this age group and can cause renal damage if not treated promptly.
- Diagnosis is based on a positive urine culture showing significant bacteriuria.
- Treatment involves antibiotics, with hospitalization for young infants or those with complications.
- Evaluation after a first UTI aims to identify risk factors for renal damage, through ultrasound, DMSA renal scan, and MCU.
Neonatal sepsis occurs when bacteria enter the bloodstream of infants less than 90 days old. It can cause overwhelming infection or spread to organs like the lungs (pneumonia) or meningitis. Common causes are E. coli, listeria, and certain streptococcus bacteria. Risk factors include preterm birth, maternal infection, and hospitalization after birth. Symptoms are non-specific but include temperature changes, breathing issues, poor feeding, and lethargy. Diagnosis involves blood, urine, and CSF tests and treatment is with antibiotics like ampicillin and gentamicin alongside supportive care. Outcomes can vary from full recovery to neurological or respiratory problems, especially in preterm infants.
Neonatal intensive care has evolved significantly since the 1900s due to advances in technology, care protocols, and therapeutics. Preterm birth remains a major challenge, with preemies facing immature organ systems and higher risks of complications like sepsis, respiratory distress, brain injuries, and more. The first hour after preterm birth less than 32 weeks is critical, and protocols aim to stabilize infants during this "golden hour." Despite gains, prematurity continues to cause mortality and morbidity. New technologies and the question of how to care for the smallest infants pose ongoing challenges for neonatal intensive care.
The document discusses the management of neonatal hypoglycemia. It defines hypoglycemia and lists its common causes such as excess insulin, limited glycogen storage, and decreased gluconeogenesis. It classifies hypoglycemia as transient or persistent and describes the management and treatment approaches for each type. Nursing management plays an important role in prevention, maintaining normal blood glucose levels, and treating hypoglycemic events. Untreated hypoglycemia can lead to serious complications affecting the brain and heart.
Neonatal sepsis remains a challenge, with rates varying significantly between institutions. While early-onset sepsis is usually caused by bacteria acquired before or during birth, late-onset sepsis often results from bacteria acquired after birth in the NICU. Diagnosis relies on clinical signs and laboratory tests like blood cultures and CRP levels. New diagnostic methods including PCR and microarrays show promise, but further studies are needed. Treatment requires appropriate empiric antibiotics while cultures are pending, with adjustments based on identified organisms and developing antimicrobial resistance patterns.
This document provides information on convulsions and epilepsy in children. It discusses the history of epilepsy, notable figures associated with epilepsy like St. Valentine, important epilepsy awareness days, common misconceptions about epilepsy, types of seizures including partial seizures, generalized seizures, absence seizures, and infantile spasms. It also covers the classification, causes, mechanisms, and syndromes of epilepsy as well as comparisons between different seizure types.
Pediatrics notes about "Neonatal Resuscitation". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
Neonatal apnea is the cessation of breathing for over 10-15 seconds, commonly affecting premature infants around 2-6 months old due to underdeveloped respiratory systems. There are three main types of apnea: central apnea caused by lack of breathing signal from the brain; obstructive apnea caused by weak respiratory muscles; and mixed apnea showing traits of both. Treatment of neonatal apnea in preterm infants involves close monitoring in the NICU, determining underlying causes, and administering medication depending on severity and type of apnea.
The document discusses the case of a 51-year-old man presenting with severe sepsis and septic shock. It outlines his initial treatment including IV fluids, antibiotics, and vasopressors. Further workup revealed a hepatic abscess which was drained surgically. The patient eventually recovered after 10 days of targeted antibiotic therapy guided by cultures. The document also reviews key literature on defining sepsis, early management principles like early goal-directed therapy, and optimization of oxygen delivery through fluid resuscitation, vasopressors, inotropes, and blood transfusions.
This document outlines best practices for infection prevention including describing the disease transmission cycle, key principles of infection prevention, and proper handwashing, antisepsis, use of personal protective equipment, safe handling of sharps, instrument processing, and waste disposal. It emphasizes that rigorous adherence to infection prevention practices such as handwashing, use of antiseptics and protective equipment, and safe disposal of contaminated waste and needles can significantly reduce the risk of infection for both healthcare staff and patients.
The patient was experiencing dizziness and had high blood pressure. The nurse assessed the patient and found their blood pressure to be elevated at 180/110. The nurse diagnosed the patient with hypertension and explained to the patient that it is a condition where blood pressure is abnormally high, putting them at risk for health problems like heart disease. The nurse's plan was to educate the patient on hypertension, identify lifestyle factors that could be contributing to it, and ensure the patient understands the importance of following their treatment plan and making healthy changes.
Neonatal sepsis is defined as a clinical syndrome of infection occurring in the first month of life, characterized by non-specific signs and symptoms. It can involve septicemia, pneumonia, or meningitis. Common causative organisms include E. coli, Staphylococcus aureus, Group B Streptococcus, and Klebsiella species. Risk factors include prematurity, prolonged rupture of membranes, and maternal fever. Diagnosis involves a sepsis screen of a complete blood count, blood culture, and C-reactive protein level. Treatment involves broad-spectrum antibiotics like ampicillin and gentamicin or cefotaxim and amikacin with supportive care. Outcomes depend on gestational age,
1. Pneumonia is an inflammatory process in the lungs that can be caused by infection or other inflammatory conditions. It causes abnormalities in lung ventilation and gas exchange.
2. Congenital pneumonia specifically refers to pneumonia that is present at birth, usually caused by viral or bacterial infections transmitted from the mother. These infections can pose serious challenges to the immature newborn.
3. Pneumonia is a major cause of neonatal mortality worldwide. It requires prompt diagnosis and treatment including antibiotics, respiratory support, and careful management of cardiac and respiratory functions to prevent complications and ensure infant survival.
This document provides information about neonatal sepsis, including its definition, classification, causes, risk factors, clinical features, diagnostic tests, management, and prevention. Some key points:
- Neonatal sepsis is a systemic bacterial infection occurring in newborns, defined as a positive blood culture within the first month of life. It is a major cause of neonatal mortality and morbidity.
- It can be classified as early-onset (before 72 hours of life) or late-onset (after 72 hours) sepsis. Early onset is usually caused by maternal genital tract bacteria, while late onset is caused by environmental and healthcare-associated bacteria.
- Risk factors include prematurity, prolonged rupture of membranes, chorio
1) Bacterial sepsis in neonates is a clinical syndrome of infection with bacteremia in the first month of life, which can lead to pneumonia or meningitis. It is a major cause of neonatal mortality.
2) Early onset sepsis occurs within 72 hours of birth and is usually caused by maternal genital tract bacteria. Late onset sepsis occurs after 72 hours and is often due to environmental bacteria or prolonged hospitalization.
3) Diagnosis is based on risk factors, clinical features and confirmation via sepsis screening tests, blood and cerebrospinal fluid cultures. Treatment involves supportive care and antibiotics.
This document discusses several common respiratory diseases that can affect newborns, including respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), meconium aspiration syndrome (MAS), primary pulmonary hypertension of the newborn (PPHN), and apnea of prematurity. It provides details on the causes, clinical presentations, diagnoses and management of each condition. The document is intended to educate medical professionals such as pediatricians on recognizing and treating respiratory issues in newborns.
The document discusses abdominal trauma, providing information on epidemiology, anatomy, classification, mechanisms of injury, signs and symptoms, diagnosis, and management. It notes that abdominal trauma can be blunt or penetrating, with the most common causes being motor vehicle accidents and assaults. Physical examination may reveal signs of internal bleeding or peritonitis, while imaging tools like ultrasound, CT scans, and diagnostic peritoneal lavage can aid in diagnosis. Resuscitation involves stabilizing the patient and controlling bleeding, while surgical intervention may be needed for injuries to hollow organs or solid organs like the liver or spleen.
This document discusses pneumonia, including its classification, pathophysiology, presentation, investigation, treatment and severity assessment. It covers community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HCAP), comparing their predisposing factors, infecting agents, and management approaches. For CAP, it recommends empirical outpatient treatment regimens based on patient risk factors. In general, the document provides a comprehensive overview of pneumonia while emphasizing differences between CAP and HCAP.
Neonatal sepsis refers to systemic bacterial infections in newborns. Early-onset sepsis occurs within 72 hours of birth and is usually caused by maternal genital tract organisms. Late-onset sepsis occurs after 72 hours and is often caused by environmental organisms acquired in the hospital or home. Treatment involves supportive care and empiric antibiotics targeting common causes like E. coli, S. aureus, and Klebsiella spp. Prompt treatment is important but overuse of antibiotics risks emerging resistance, so diagnosis is confirmed using blood cultures and sepsis screening tests when possible. Outcomes depend on the infant's health and prompt, appropriate treatment.
Bacterial Meningitis in Paediatrics A Review.pdfPUBLISHERJOURNAL
Emmanuel Ifeanyi Obeagu1, Sowdo Abdirizak Mohamed2, Ugwu Okechukwu Paul-Chima3, Getrude Uzoma Obeagu4 and Chukwunalu Igbudu Umoke5
1Department of Medical Laboratory Science, Kampala International University, Uganda.
2Department of Pediatrics, Kampala International University, Uganda.
3Department of Publication and Extension, Kampala International University, Uganda.
4Department of Nursing Science, Kampala International University, Uganda.
5Department of Human Anatomy, Alex Ekwueme Federal University, Ndufu Alike, Ikwo, Ebonyi State, Nigeria.
Email:emmanuelobeagu@yahoo.com
________________________________________
ABSTRACT
Meningitis is a potentially life-threatening condition characterized by infection or inflammation of the central nervous system. It is classified as bacterial, viral, or aseptic. Delayed or untreated bacterial meningitis is associated with high morbidity and mortality. It is important to accurately distinguish between bacterial and nonbacterial meningitis. Most physicians will perform a lumbar puncture and consider antibiotics for all infants and children with suspected meningitis. Having a clinical prediction rule to determine the need for lumbar puncture and which patients need antibiotics could reduce morbidity and the cost associated with unnecessary procedures and treatment. Several clinical prediction rules to determine the risk of bacterial meningitis have been proposed. One clinical prediction rule, derived and validated from cohorts seen in pediatric hospitals in the Netherlands, found that altered consciousness, meningeal irritation, cyanosis, petechiae, vomiting, duration of main symptom, and an elevated C-reactive protein and Erythrocyte Sedimentation Rate level were independent predictors of bacterial meningitis. Patients below a predefined threshold on a risk score incorporating these elements could be safely considered as not having bacterial meningitis.
Keywords: Bacteria, Meningitis, petechiae, C - reactive protein, pediatrics, ESR
This document provides an overview of neonatal sepsis, including its definition, etiology, classification, pathophysiology, symptoms and signs, laboratory tests, and treatment. Neonatal sepsis is defined as an invasive bacterial infection occurring in infants under 1 month of age. It can be classified as early onset (within 7 days of birth) or late onset (after 7 days). Causes include bacteria acquired from the mother during birth or later from the hospital environment. Symptoms can be nonspecific but include temperature instability, respiratory issues, and feeding problems. Treatment involves supportive care and empiric antibiotic therapy based on risk factors.
Neonatal sepsis is a clinical syndrome of systemic illness accompanied by bacteria in the blood occurring in the first month of life. It can be early-onset within the first week of life, usually acquired during birth from the mother, or late-onset between 1 week to 1 month of life, often from hospital-acquired infections. Symptoms are non-specific but can include temperature irregularities, poor feeding, or respiratory distress. Treatment involves blood cultures, antibiotics like ampicillin and gentamicin, and supportive care for complications involving various organ systems. Ongoing research focuses on immunotherapies and blocking inflammatory responses.
This document provides information on neonatal septicemia (neonatal sepsis), including defining it, describing risk factors and causes, clinical features, differential diagnoses, investigations, treatment, management, complications and prevention. Key points covered are that neonatal sepsis is a systemic bacterial infection in newborns, treatment should never be delayed for investigations, and combination antibiotic therapy is important. Prevention involves good antenatal care and exclusive breastfeeding.
1. Perinatal infections occur during labor and delivery when microbial agents infect the infant. The most common sources are the maternal genital tract and amniotic fluid. 2. The newborn is initially colonized by microbes on the skin and mucosal surfaces, which sometimes cause illness by direct extension or bloodstream invasion. 3. Risk factors for neonatal sepsis include low birth weight, premature rupture of membranes, and maternal infection. The most common causes are Group B Streptococcus and E. coli from the maternal genital tract.
Neonatal sepsis occurs when pathogenic organisms enter the bloodstream of newborns, potentially causing infections like septicemia, pneumonia, or meningitis. Worldwide it accounts for 15% of neonatal deaths. In Nepal, neonatal sepsis causes 47.7% of neonatal deaths. It can be early onset within 3 days of life due to maternal infections, or late onset after 3 days from hospital-acquired infections. Common causes are E. coli, Staphylococcus aureus, and Klebsiella. Risk factors include prematurity, low birth weight, maternal infections, and lack of breastfeeding. Symptoms include pallor, apnea, bulging fontanel, and poor feeding. Diagnosis involves sepsis
Neonatal sepsis occurs when pathogenic organisms enter the bloodstream of newborns, potentially causing infections like septicemia, pneumonia, and meningitis. It accounts for 15-47.7% of neonatal deaths worldwide. Symptoms develop within 3 days (early onset) or after 3 days (late onset) and include pallor, apnea, bulging fontanel, and poor feeding. Escherichia coli, Staphylococcus aureus and Klebsiella are common causes. Diagnosis involves sepsis screening and CSF analysis. Treatment requires appropriate antibiotics based on culture and supportive care like IV fluids and oxygen. Outcomes depend on the infant's weight and maturity as well as the causative organism and treatment
The document discusses vaccination and immunization. It provides details on:
- The differences between the immune systems of children and adults. Children rely on maternal antibodies at birth that wane after 1 year of age.
- The types of vaccines including live attenuated, inactivated, toxoid, subunit, and genetic vaccines. It also discusses the Iraqi and global vaccination schedules.
- Immunoglobulins including normal human Ig and specific human Ig used for passive immunity. Adverse reactions can include pain, fever, and allergic reactions.
- Maintaining the cold chain is important to preserve vaccine potency during storage and handling.
- Factors that can constrain widespread effective vaccination including illiteracy,
H.D. is a preterm newborn with risk factors for sepsis including prematurity, low birth weight, and maternal risk factors. Clinical signs observed in H.D. that indicate sepsis include tachycardia, hypothermia, leukopenia, neutropenia, and an elevated C-reactive protein level. Empiric intravenous antibiotic treatment with ampicillin and an aminoglycoside such as gentamicin should be started immediately to treat potential bacterial infections like group B streptococcus while culture results are pending. Management of neonatal sepsis aims to identify the pathogen, treat with appropriate antibiotics to prevent mortality and complications like meningitis, and consider switching or adding antibiotics based on suspected organism and patient condition.
Bacterial meningitis in neonates remains devastating despite advances in treatment. Initial empirical antibiotic therapy depends on factors like age and suspected pathogens. Common early pathogens include GBS, E.coli, and Listeria. Later pathogens include additional gram-negative organisms. Supportive care includes fluid maintenance, hypoglycemia control, and ventilator support. Antibiotics should achieve adequate CSF penetration and coverage. Duration of therapy ranges from 14-21 days depending on causative organism and CSF sterilization. Repeat CSF analysis within 48 hours helps evaluate response to treatment.
Neonatal infections, especially sepsis, continue to be a significant cause of morbidity and mortality in newborns. Sepsis is caused by microorganisms or their toxins in the blood or tissues. There are two patterns of neonatal bacterial infection - early-onset within 24-48 hours of birth often caused by maternal vaginal flora, and late-onset after 2 weeks of age which may be acquired from the birth canal or external environment. Risk factors include preterm birth, prolonged rupture of membranes, maternal fever or infection. Signs of sepsis include respiratory distress, temperature instability, feeding intolerance and jaundice. Treatment involves administering IV antibiotics and supportive care while monitoring for improvement.
Neonatal infectious diseases jornal 2nd topicRobin Thomas
This document summarizes neonatal sepsis, which is divided into early onset sepsis (EOS) occurring in the first week of life, and late onset sepsis (LOS) occurring after the first week. EOS is often caused by maternal transmission of organisms like Group B Streptococcus. LOS is attributed to postnatal pathogens acquired in the hospital and common organisms include coagulase-negative Staphylococci. Preterm and very low birth weight infants are especially at risk due to immunological immaturity. Blood cultures remain the gold standard for diagnosis but biomarkers like CRP and PCT are also used. Prevention strategies focus on identifying at-risk mothers, intrapartum antibiotic prophylaxis, and reducing hospital-acquired
Neonatal sepsis (sepsis on new born) with case presentationJOEL RAJAN U
Newborn sepsis is a severe infection in an infant younger than 28 days old. A newborn may become infected before, during, or after birth. Newborn sepsis can be hard to diagnose. Early diagnosis and treatment are the best ways to stop sepsis.
This document summarizes meningitis in children, including the definition, causes, signs and symptoms, diagnosis, treatment, and prevention. Meningitis is an inflammation of the membranes surrounding the brain and spinal cord. It most commonly affects infants and children under 5 years old. Bacteria such as pneumococcus, meningococcus, and H. influenzae are common causes. Signs include fever, headache, neck stiffness, and altered mental status. Diagnosis involves lumbar puncture and culture of spinal fluid. Treatment involves antibiotics and supportive care. Vaccines can help prevent certain bacterial types. Complications may include neurological deficits if not treated promptly.
This document discusses the management of neonatal sepsis and identifies areas of potential malpractice. It presents two case studies of neonates with sepsis that were potentially mismanaged. The document then outlines key topics to be covered, including features of neonatal sepsis, the role of CRP and procalcitonin in diagnosis, treatment planning considerations, controversies around certain drug uses, the role of blood exchange transfusions, and potential adjuvant therapies. Overall, the document aims to improve management of neonatal sepsis by revising basic knowledge around appropriate diagnosis and treatment.
This document provides an overview of central nervous system (CNS) infections. It discusses the anatomy of the CNS and cerebrospinal fluid characteristics. The major causes of bacterial meningitis include Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. Fungal, mycobacterial, spirochetal and viral infections can also affect the CNS. Clinical presentation depends on the specific organism and may include symptoms like fever, headache, vomiting and altered mental status. Diagnosis involves CSF analysis and other tests. Timely treatment is important but infections can still cause long-term complications.
Infections and salivary gland disease in pediatric age: how to manage - Slide...WAidid
The slideset by Professor Susanna Esposito aims at explaining how to manage the salivary gland infections in pediatric age, from pathogenesis, to transmission, treatments and vaccination coverage, that should be urgently increased in Italy as well as in EU Countries.
This document provides an overview of neonatal infections, including epidemiology, predisposing factors, etiology, pathogenesis, clinical presentation, investigations, management, prevention, and specific infections such as sepsis, meningitis, ophthalmia neonatorum, and viral infections like cytomegalovirus, rubella, hepatitis, and HIV. Neonatal infections are a major cause of morbidity and mortality in newborns, and can be either early-onset within 3 days of birth or late-onset acquired from the environment. Bacteria are the most common cause but viruses, fungi and protozoa can also infect newborns.
2. Definition
‡ Neonatal sepsis is defined as a clinical syndrome
of bacteremia with systemic signs and symptoms
of infection in the first 4 weeks of life.
‡ When pathogenic bacteria gain access into the
blood stream, they may cause overwhelming
infection without much localization (septicemia)
or may get predominantly localized to the lung
(pneumonia) or the meninges (meningitis).
3. Classification
‡ Neonatal sepsis can be classified into two
sub-types depending upon whether the onset
of symptoms is before 72 hours of life (early
onset) or later (late onset).
4. Etiology
‡ The microorganisms most commonly associated with early-
onset infection include group B Streptococcus (GBS),
Escherichia coli , coagulase-negative Staphylococcus,
Haemophilus influenzae.
‡ Meningoencephalitis and neonatal sepsis syndrome can
also be caused by infection with adenovirus, enterovirus, or
coxsackievirus.
‡ Additionally, sexually transmitted diseases (eg, gonorrhea,
syphilis, herpes simplex virus [HSV], cytomegalovirus
[CMV], hepatitis, human immunodeficiency virus [HIV],
rubella, toxoplasmosis, Trichomonas vaginalis, Candida
species) have all been implicated in neonatal infection.
5. Early onset Sepsis
‡ Early-onset infections are caused by organisms prevalent in
the maternal genital tract or in the delivery area.
‡ The associated factors for early-onset sepsis include
± low birth weight,
± prolonged rupture of membranes,
± foul smelling liquor,
± multiple per vaginum examinations,
± maternal fever,
± difficult or prolonged labour
± aspiration of meconium.
‡ Early onset sepsis manifests frequently as pneumonia and
less commonly as septicemia or meningitis.
6. Late Onset Sepsis
‡ Late-onset septicemia is caused by the organisms thriving in the
external environment of the home or the hospital.
‡ The infection is often transmitted through the hands of the care-
providers.
‡ The associated factors of late-onset sepsis include:
± low birth weight,
± lack of breastfeeding,
± superficial infections (pyoderma, umbilical sepsis),
± aspiration of feeds,
± disruption of skin integrity with needle pricks
± use of intravenous fluids.
‡ These factors enhance the chances of entry of organisms into the
blood stream of the neonates whose immune defences are poor as
compared to older children and adults.
7. PathoPhysiology
‡ Numerous host factors predispose the
newborn infant to sepsis:
‡ It involves all levels of host defense, including
± cellular immunity,
± humoral immunity,
± barrier function.
8. Cellular immunity
‡ Is mainly divided into 4 main components:
‡ neonatal neutrophil or polymorphonuclear (PMN) cell:
± is vital for effective killing of bacteria
± is deficient in chemotaxis and killing capacity
± neutrophil reserves are easily depleted because of the diminished
response of the bone marrow, especially in the premature infant.
‡ Neonatal monocyte
± concentrations are at adult levels; however,
± macrophage chemotaxis is impaired and continues to exhibit
decreased function into early childhood.
± The absolute numbers of macrophages are decreased
± The chemotactic and bacteriocidal activity and the antigen
presentation by these cells are also not fully competent at birth.
9. Cellular immunity
‡ T cells
± Found in early gestation and incrase till 6months of life
± Cell are immature
± Do not proliferate as readily as adult T cells
± The cytotoxic function of the T celss are only 50% of the adult T
cell
± Important factor is that new borns are lacking of memory T cells
‡ Natural Killer Cells
± Found in sma;; numbers
± Functionally immature as they produce very low levels of
interferon Gamma upon primary stimulation compared to adult
NK cells
10. Humoral immunity
‡ fetuses has some preformed immunoglobulin present,
primarily acquired through nonspecific placental
transfer from the mother
‡ Ability of the neonate to generate Ig in response to
antigenic stimulation is intact but response is initially
decreased and rapidly rises with increasing postnatal
age.
‡ The neonate is also capable of synthesizing
immunoglobulin M (IgM) in utero at 10 weeks'
gestation; however, IgM levels are generally low at
birth, unless the infant was exposed to an infectious
agent during the pregnancy
11. Humoral immunity
‡ Most of the IgG is acquired from the mother during
late gestation
‡ The neonate may receive immunoglobulin A (IgA) from
breastfeeding but does not secrete IgA until 2-5 weeks
after birth.
‡ Complement protein production can be detected as
early as 6 weeks' gestation; however, the concentration
of the various components of the complement system
widely varies among individual neonates.
‡ Mature complement activity is not reached until
infants are aged 6-10 months.
12. Barrier function
‡ Phisical an chemical barriers are present in
infants but are immature
‡ In premature infants, skin and mucous
membranes are easily broken down
‡ Invasive procedures cause an increased risk of
contracting an infection especially in those
who are clinically ill and are in the hospital.
13. Clinical features
‡ The manifestations of neonatal septicemia are often vague and
therefore demand a high index of suspicion for early diagnosis.
‡ The most common and characteristic manifestation is an alteration
in the established feeding behavior in late onset sepsis and
respiratory distress in early onset sepsis.
‡ Hypothermia is a common manifestation of sepsis, whilst fever is
infrequent.
‡ Diarrhea, vomiting and abdominal distension may occur.
‡ Episodes of apneic spells or gasping may be the only manifestation
of septicemia.
‡ In sick neonates, the skin may become tight giving a hide-bound
feel (sclerema) and the perfusion becomes poor (capillary refill time
of over 3 seconds).
14. Clinical Features in localized sepsis
‡ The additional features of pneumonia or meningitis may be present
‡ The evidence of pneumonia includes
± tachypnea,
± chest retractions,
± grunting,
± early cyanosis
± apneic spells
± Cough is unusual.
‡ Meningitis is often silent, the clinical picture being dominated by
manifestations of associated septicemia.
‡ However, the appearance of excessive or high-pitched crying, fever,
seizures, blank look, neck retraction or bulging anterior fontanel are
highly suggestive of meningitis.
15. WHO study published in 2003
‡ identified nine clinical features which predict severe
bacterial illness in young infants
1. Feeding ability reduced
2. No spontaneous movement
3. Temperature >38 C
4. Prolonged capillary refill time
5. Lower chest wall in drawing
6. Resp rate > 60/minute
7. Grunting
8. Cyanosis
9. H/o of convulsions
16. Investigations
‡ The CSF findings in infectious neonatal meningitis are an elevated WBC count
(predominately PMNs), an elevated protein level, a decreased CSF glucose
concentration, and positive culture results.
‡ An absolute neutrophil count of < 1800 per cmm is an indicator of infection.
‡ Immature neutrophils (Band cells + myelocytes + metamyelocytes) to total
neutrophils ratio (l/T) > 0.20
‡ Platelet count of less than 100,000 per cmm
‡ C-reactive protein (CRP) which has a high degree of sensitivity for neonatal sepsis
‡ A practical positive "sepsis screen" takes into account two or more positive tests as
given below:
1. Leukopenia (TLC <5000/cmm)
2. Neutropenia (ANC <1800/cmm)
3. Immature neutrophil to total neutrophil (I/T) ratio (> 0.2)
4. Micro ESR (> 15mm 1st hour)
5. CRP +ve
17. Treatment
‡ No investigation is required as a prerequisite to
start treatment in a clinically obvious case.
‡ Supportive care and antibiotics are two equally
important components of the treatment.
‡ It should be realized that antibiotics take at least
12 to 24 hours to show any effect and it is the
supportive care that makes the difference
between life and death early in the hospital
course.
18. Supportive care
‡ The purpose of supportive care is to:
± normalize the temperature,
± stabilize the cardiopulmonary status,
± correct hypoglycemia and
± prevent bleeding tendency
19. Supportive care of a septic neonate
1. Provide warmth, ensure consistently normal temperature
2. Start intravenous line.
3. Infuse normal saline 10 ml/kg over 5-10 minutes, if perfusion is poor as
evidenced by capillary refill time (CRT) of more than 3 seconds. Repeat the
same dose 1-2 times over the next 30-45 minutes, if perfusion continues
to be poor.
4. Infuse glucose (10 percent) 2 ml/kg stat.
5. Inject Vitamin K 1 mg intramuscularly.
6. Start oxygen by hood or mask, if cyanosed or grunting.
7. Provide gentle physical stimulation, if apneic.
8. Provide bag and mask ventilation with oxygen if breathing is inadequate.
9. Avoid enteral feed if very sick, give maintenance fluids intravenously
10. Consider use of dopamine if perfusion is persistently poor.
11. Consider exchange transfusion if there is sclerema.
20. Treatment
‡ Antibiotic therapy should cover the common causative bacteria,
namely, Escherichia coli, Staphylococcus aureus and Klebsiella
pneumoniae.
‡ A combination of ampicillin and gentamicin is recommended for
treatment of sepsis and pneumonia.
‡ In cases of suspected meningitis, cefotaxime should be used along
with an aminoglycoside.
‡ On confirmation of sensitivity pattern, appropriate antibiotics are
used singly or in combination.
‡ In a baby in whom the antibiotics were started on low suspicion,
these may be stopped after 3 days, if baby is clinically well
‡ if a baby appears ill even though the cultures are negative,
antibiotic therapy should be continued for 7 to 10 days .
21. Superficial infections
‡ Superficial infections can be treated with local
application of antimicrobial agents.
‡ Pustules can be punctured with sterile needles and
cleaned with spirit or betadine.
‡ Purulent conjunctivitis can be treated with neosporin
or chloramphenicol ophthalmic drops.
‡ Oral thrush responds to local application of
clotrimazole or nystatin (200,000 units per ml) and
hygienic precautions.
‡ Superficial infections must be adequately managed; if
neglected they can lead to sepsis or even an epidemic.
22. Prevention of infections
‡ A good antenatal care goes a long way in decreasing
the incidence, morbidity and mortality from neonatal
sepsis.
‡ All mothers should be immunized against tetanus.
‡ All types of infections should be diagnosed early and
treated vigorously in pregnant mothers.
‡ Babies should be fed early and exclusively with
expressed breast milk (or breastfed) without any
prelacteal feeds.
‡ Cord should be kept clean and dry. Unnecessary
interventions should be avoided.
23. Hand washing
‡ This is the simplest and the most effective
method for control of infection in the hospital.
‡ All persons taking care of the baby should strictly
follow hand washing policies before touching any
baby.
‡ The sleeves should be rolled above the elbows.
‡ Rings, watches and jewellery should be removed.
‡ Hand should be washed with a thorough scrub
for 2 minutes before starting to see patients and
washed again for 20 second in between patients.
24. Prevention of infection in hospital
‡ The nursery environment should be clean and dry with
24 hour water supply and electricity.
‡ The nursery temperature should be maintained
between 30+2°C.
‡ All procedures should be performed after wearing
mask and gloves.
‡ Unnecessary invasive interventions such as needle
pricks and setting up of intravenous lines should be
kept to the barest minimum.
‡ Every baby must have separate thermometer and
stethoscope( if possible) and all barrier nursing
measures must be followed.
26. Defination
‡ Pneumonia is an inflammatory pulmonary
process that may originate in the lung or be a
focal complication of a contiguous or systemic
inflammatory process within the first 24 ʹ 48
hours of life.
27. Pathogenesis
‡ In neonatal pneumonia, pulmonary and extrapulmonary injuries are
caused directly and indirectly by invading microorganisms or foreign
material and by poorly targeted or inappropriate responses by the
host defense system that may damage healthy host tissues as badly
or worse than the invading agent.
‡ Direct injury by the invading agent usually results from synthesis
and secretion of microbial enzymes, proteins, toxic lipids, and toxins
that disrupt host cell membranes, metabolic machinery, and the
extracellular matrix that usually inhibits microbial migration.7,8
‡ Indirect injury is mediated by structural or secreted molecules
which may alter local vasomotor tone and integrity, change the
characteristics of the tissue perfusate, and generally interfere with
the delivery of oxygen and nutrients and removal of waste products
from local tissues.
28. Risk Factors
‡ Unexplained preterm labor
‡ Rupture of membranes before the onset of labor
‡ Membrane rupture more than 18 hours before delivery
‡ Maternal fever (>38°C/100.4°F)
‡ Uterine tenderness
‡ Foul-smelling amniotic fluid
‡ Infection of the maternal genitourinary tract
‡ Previous infant with neonatal infection
‡ Nonreassuring fetal well-being test results
‡ Fetal tachycardia
‡ Meconium in the amniotic fluid
‡ Recurrent maternal urinary tract infection
‡ Gestational history of illness consistent with an organism known to have
transplacental pathogenic potential
29. Clinical signs & symptoms
‡ may be pulmonary or systemic
‡ Pulmonary:
‡ Persistent tachypnea (respiratory rate >60/min)
‡ Expiratory grunting may occur.
‡ Accessory respiratory muscle recruitment, such as nasal flaring and retractions at subcostal,
intercostal, or suprasternal sites, may occur.
‡ Airway secretions may vary substantially in quality and quantity.
‡ If aspiration of meconium, blood, or other proinflammatory fluid is suspected, other colors and
textures reflective of the aspirated material may be seen.
‡ Rales, rhonchi, and cough are all observed much less frequently in infants with pneumonia than in
older individuals.
‡ Cyanosis of central tissues, such as the trunk, implies a deoxyhemoglobin concentration of
approximately 5 g/dL or more and is consistent with severe derangement of gas exchange from
severe pulmonary dysfunction as in pneumonia,
‡ Infants may have external staining or discoloration of skin, hair, and nails with meconium, blood, or
other materials when they are present in the amniotic fluid.
‡ Increased respiratory support requirements such as increased inhaled oxygen concentration,
positive pressure ventilation, or continuous positive airway pressure are commonly required before
recovery begins.
‡ Infants with pneumonia may manifest asymmetry of breath sounds and chest excursions, which
suggest air leak or emphysematous changes secondary to partial airway obstruction.
30. Systemic findings
‡ Similar to signs and symptoms seen in sepsis or
other severe infectionsTemperature instability
± Skin rash
± Jaundice at birth
± Tachycardia
± Glucose intolerance
± Abdominal distention
± Hypoperfusion
± Oliguria
31. Laboratory Studies
‡ Aspiration Culture
‡ Blood culture
‡ Culture of specimens from lumbar puncture
‡ Urine culture
‡ Imaging Studies
± Radiography
± Ultrasonography
‡ Ultrasonography is particularly useful for identifying
and localizing fluid in the pleural and pericardial spaces.
32. Treatment
‡ Antimicrobial therapy
± initial empiric therapy consists of ampicillin and either gentamicin or
cefotaxime
± Drainage of a restrictive or infected effusion or empyema may enhance
clearance of the infection and improves lung mechanics.
‡ Respiratory support
± Criteria for institution and weaning of supplemental oxygen and mechanical
support are similar to those for other neonatal respiratory diseases.
‡ Hemodynamic support
± Delivery of adequate amounts of glucose and maintenance of
thermoregulation, electrolyte balance, and other elements of neonatal
supportive care are also essential aspects of clinical care.
‡ Nutritional support:
± Attempts at enteral feeding often are withheld in favor of parenteral
nutritional support until respiratory and hemodynamic status is sufficiently
stable.