PRESENTED BY :
• Infection is still one of the leading causes of
neonatal death in developing countries.
• The neonates are more susceptible to infection
as they are deficient in natural immunity and
• Preterm infants are at high risk for perinatal
• Neonates that survive from sepsis often suffer
from severe neurological as well as severe
parenchymal lung diseases.
RISK FACTORS FOR NEONATAL INFECTION
• Rupture of membrane > 18 hours
• Maternal intrapartum fever > 100.4˚F
• Low birth weight infant (< 2500 g)
• Prematurity (< 37 weeks)
• Male infant
• Mother with Gr. B β haemolytic streptococcal
• Repeated vaginal examination in labour
• Invasive procedures of monitoring
MODE OF INFECTION
• Transplacental : maternal infection that can
affect the fetus through transplacental route are
predominantely the viruses, they are rubella,
cytomegalovirus, herpes virus, HIV, chicken pox
and hepatitis – B virus. Other infections are
syphilis, toxoplasmosis and tuberculosis.
• Aminonitis : amnionitis following premature
rupture of the membranes can affect the baby
following aspiration or ingestion of infected
• - aspiration of infected liquor or
meconium following early rupture of
the membranes or repeated internal
examination. This may lead to
neonatal sepsis, pneumonia and
• - while the fetus is passing through
the infected vagina – (a) eyes are
infected – opthalmia neonatorum or
(b) oral thrush with candid albicans.
• - Improper asepsis while caring the
Postnatal – nosocomial infections
• Transmission due to human
contact – infected mother, relative
or staff of the nursery.
• Cross infection from an infected
baby in the nursery.
• Infection through feeding, bathing,
clothing or air-borne.
• Infection in environment of
neonatal intensive care (NICU) or
The common pathogens are :
• group B streptococcus (GBS),
Staphylococcus aureus, E. coli,
klebsiella and pseudomonas, fungus
(candida) and anaerobes.
• The infant is acquired during
intrapartum period from the genital
• The infant is colonised with the
pathogens in the perinatal period.
• The primary sites of colonisation are :
skin, nasopharynx, oropharynx,
conjunctiva and umbilical cord.
COMMON SITES OF INFECTION
Trivial but may be serious :
• Eyes – opthalmia neonatorum
• Oral thrush
Severe systematic :
• Respiratory tract
• Intra – abdominal infections
• Antibiotic therapy – broad spectrum are given to cover
the germ positive and negative organisms as well as the
anaerobes. Inj. Ampicillin 150 mg/kg/every 12 hours,
gentamycin 3-4 mg/kg/every 24 hours, usually are
started. In a severely ill patient, cefotaxime or
ceftazidime is also added.
• Supportive therapy and management of complications as
needed. E.g. mechanical ventilation for RDS, dopamine
for hypotension, ant convulsion for seizure sodium
bicarbonate for metabolic acidosis and Immunotherapy
with hyper immune globulins.
Congenital syphilis is caused by transplacental
transmission of spirochetes; the transmission rate
approaches 90% if the mother has untreated primary or
secondary syphilis. Fetal infection can develop at any time
during gestation. Manifestations are defined as early if they
appear in the first 2 years of life and late if they develop
after age 2 years.
• Congenital syphilis is a severe, disabling, and often life-
threatening infection seen in infants. A pregnant mother
who has syphilis can spread the disease through the
placenta to the unborn infant.
• Congenital syphilis is syphilis present in utero and at
birth, and occurs when a child is born to a mother
with secondary syphilis. Untreated syphilis results in a
high risk of a poor outcome of pregnancy.
Congenital syphilis is caused by the bacterium Treponema
pallidum, which is passed from mother to child during fetal
development or at birth. Nearly half of all children infected
with syphilis while they are in the womb die shortly before
or after birth.
• The risk of infecting the baby is greatest when the
mother is in the early stages of syphilis. But infection is
possible any time during pregnancy.
Early-onset congenital syphilis (diagnosed before or at
age 2 y)
• Symptoms in newborns may include:
• Failure to gain weight or failure to thrive
• No bridge to nose (saddle nose)
• Rash of the mouth, genitals, and anus
• Rash -- starting as small blisters on the palms and soles,
and later changing to copper-colored, flat or bumpy rash
on the face, palms, and soles
• Watery fluid released from the nose
LATE ONSET CONGENITAL SYPHILLIS
• blunted upper incisor teeth known as Hutchinson's teeth
• Abnormal notched and peg-shaped teeth, called
• hard palate defect
Inflammation of the cornea known as interstitial keratitis
• Blindness -
• Clouding of the cornea
EAR & NOSE
• deafness from auditory nerve disease
• saddle nose (collapse of the bony part of nose)
• snuffles, aka "syphilitic rhinitis", which appears similar to
the rhinitis of the common cold, except it is more severe,
lasts longer, often involves bloody rhinorrhea, and is
often associated with laryngitis.
• Bone pain
• Refusal to move a painful arm or leg
• Joint swelling
• Scarring of the skin around the mouth, genitals, and
• Gray, mucus-like patches on the anus and outer vagina
• Saber shins (bone problem of the lower leg)
Opthalmia neonatorum is defined as inflammation of
conjunctiva during first month of life.
• Chlamydia trachomatis (oculogenitalis)
• Other bacterial causes : gonococcus (rare),
staphylococcus, pseudomonas, etc.
• Chemical – silver nitrate
• Viral : herpes simplex (type II)
MODE OF INFECTION
• Infection occurs mostly during delivery by contaminated
• It is more likely ion face or breech delivery.
• During neonatal period, there may be direct
contamination from other sites of infection or by
• It is varies
• the discharge may be watery, mucopurulent to frank
purulent in one or both eyes.
• The eyelids may be sticky or markedly swollen.
• Cornea may be involved in severe cases.
PROGNOSIS & PREVENTION
• It is favourable to most cases except in neglected
cases with rare gonococcal infection. Fortunately,
effective methods of prophylaxis and treatment
have almost eliminated the risk of blindness.
• Any suspicious vaginal discharge during the
antenatal period should be treated and the most
meticulous obstetric asepsis is maintained at birth.
The newborn baby’s closed lids should be
thoroughly cleansed and dried.
The discharge is taken for –
(a)gram stain smear
(b)culture and sensitivity
(c) scraping material from lower conjunctiva for
Giemsa staining and also culture in suspected
chlamydial infection (d) culture in special viral
media for suspected herpes simplex infection.
Prophylaxis : 1% silver nitrate solution (1-2 drops to each
eye), 0.5% erythromycin opthalmic ointment, 2.5%
povidone iodine solution is administered within 1 hour of
birth and is continued for few days.
Treatment depend upon the specific aetiology.
• Gonococcal – infant is isolated during the first 24 hours
of treatment. Eyes are irrigated with sterile isotonic
saline evert 1-2 hours until clear. In severe and culture
positive cases systemic ceftriaxone 50 mg/kg/q 12 h is
given IM/IV. Single dose in infant without dissemination
or for 7 days when there is dissemination, is usually
• Chlamydia – erythromycin suspension 40 mg/kg daily
orally divided into 4 doses for 14 days is given to prevent
systemic infection. Topical treatment alone is ineffective.
• Herpes simplex – the infant is isolated. Systemic
t=herapy with acyclovir 20 mg/ kg every 8 hours for 2
weeks is given IV. Topical use of 0.1% iododoxyuridine
ointment 5 times a day for 10 days is used.
• Neonatal sepsis is a blood infection that
occurs in an infant younger than 90 days
old. Early-onset sepsis is seen in the first
week of life. Late-onset sepsis occurs
between days 8 and 89.
• Neonatal sepsis specifically refers to the
presence in a newborn baby ("neonate") of
a bacterial blood stream infection(BSI) (such
as meningitis, pneumonia, pyelonephritis,
or gastroenteritis) in the setting of fever.
Neonatal sepsis is a bacterial infection in the blood. It is
found in infants during the first month of life. This may
become a serious condition. If you suspect your infant has
this condition, contact your doctor right away.
CAUSES & RISK FACTORS
SOURCE RISK FACTORS
Maternal Low socioeconomic status
Poor prenatal care
Intrapartum Premature rupture of membranes
Rupture of membranes >12 -18hr
Maternal urinary tract infection
SOURCE RISK FACTORS
Neonatal Twin or multiple gestation
Congenital anomalies of skin or
Absence of spleen
Low birth weight or prematurity
Early-onset neonatal sepsis
• The microorganisms most commonly associated with
early-onset neonatal sepsis include the following :
• E coli
• Coagulase-negative Staphylococcus
• H influenzae
• L monocytogenes
Late-onset neonatal sepsis
Organisms that have been implicated in causing late-onset
neonatal sepsis include the following:
• Coagulase-negative staphylococci
• S aureus
• E coli
Respiratory Apnea, bradycardia
Grunting, nasal flaring
Decreased oxygen saturation
Cardiovascular Decreased cardiac output
Central nervous Temperature instability
• Blood tests such as complete blood count
Cerebrospinal fluid—through lumber puncture
• X-rays of the chest or abdomen
• Coagulation studies – DIC can occur in infected newborn
• Chest radiography, CT Scan or MRI – in suspected
• Treatment depends on how severe the condition is. If
sepsis is suspected, your infant will be hospitalized while
you wait for test results.
• Antibiotics - Antibiotic medicine may have to be given
directly into the vein (IV).
• Intravenous Fluids - IV fluids will help support your
infant until the infection clears. It may include fluids,
glucose, and electrolytes.
• Oxygen - infant may need oxygen therapy. In more
severe cases, a ventilator may be used to support
• Because of gastrointestinal (GI) symptoms, feeding
intolerance, or poor feeding, it may be necessary to give
the neonate nothing by mouth (nil per os; NPO) during
the first days of treatment. Consider parenteral nutrition
to ensure that the patient’s intake of calories, protein,
minerals, and electrolytes is adequate during this period.
• For the infant whose condition is seriously compromised,
feeding may be restarted via a nasogastric tube For
most infants, breast milk is the enteral diet
recommended by the American Academy of Pediatrics
• An infectious disease consultation is useful, especially if
the infant is not responding to treatment, is infected with an
unusual organism, or has had a complicated clinical
course. If neonatal meningitis is identified, consultation with
a pediatric neurologist may be necessary for assistance
with outpatient follow-up of neurologic sequelae. Inpatient
consultation may be necessary if meningitis is complicated
• Consultation with a pediatric pharmacologist may be helpful
for obtaining advice on the most appropriate antibiotic or
dosage to use if changes in the drug regimen prove
necessary because of inadequate or toxic drug levels
obtained with therapeutic monitoring. A pediatric surgical
consultation may be necessary if sepsis is complicated by
abscess, if the differential diagnosis includes necrotizing
enterocolitis (NEC), or if central line placement is required.
• The primary care provider (PCP) should evaluate the
infant with neonatal sepsis within 1 week of discharge
from the hospital. The infant can be evaluated for
superinfection and bacterial colonization associated with
antibiotic therapy, especially if the therapy was
prolonged. The PCP should evaluate growth and
determine whether the feeding regimen and activity have
returned to normal.
• If neonatal sepsis was associated with meningitis,
prolonged hypoxia, extracorporeal membrane
oxygenation therapy, or brain abscess formation, the
infant should be observed for several years to assess
neurodevelopment. If problems are found, the child
should receive appropriate early intervention services
• Antibiotics commonly used - ampicillin, gentamicin,
cefotaxime, vancomycin, metronidazole, erythromycin,
and piperacillin. The choice of antibiotic agents should
be based on the specific organisms associated with
sepsis, the sensitivities of the bacterial pathogen, and
the prevailing nosocomial infection trends in the nursery.
Viral infections, such as herpes and fungal infections,
can masquerade as bacterial infections.
• Antibiotics can control dangerous bacteria in the mother.
It will prevent the spread of bacteria during pregnancy or
birth to the infant. Your doctor may recommend
• The birth mother has previously given birth to an infant
with neonatal sepsis.
• You have had a positive bacterial infection test before
your due date.
• Breastfeeding may also help prevent sepsis in some
• Follow steps to prevent premature labor or birth. This
can include proper prenatal care, avoiding drugs and
alcohol, and eating a healthy balanced diet.
• Risk for in fection related to
• Maternal vaginal (or other) infection
• Indwelling umbilical catheters, parenteral fluids
• Intrauterine electronic fetal monitoring
• Dysmaturity, IUGR, gestational age
• Ineffective thermoregulation related to
• systemic infection
• Impaired skin integrity related to
• use of multiple supportive invasive measures (e.g,
physiologic monitoring, parenteral fluid therapy,
• Acute pain related to
• Multiple supportive invasive measures
PARENTS AND FAMILY
• Anxiety, fear, or anticipatory grieving related to
• Uncertainty about infant’s prognosis
• Therapy (invasive)
• Risk for impaired parent-infant attachment related to
• Separation of parent and newborn
• Feelings of inadequacy in caring for infant
• Powerlessness or spiritual distress related to
• Perinatal events or newborn’s condition beyond