NEONATAL SEPSIS

Introduction
Neonatal sepsis is the single most important cause of
neonatal deaths in the community,accounting for over half of
them.If diagnosed early and treated aggressively with antibiotics
and good supportive care,it is possible to save most cases of
neonatal .
Definition
When pathogenic bacteria gain access into the blood
stream,they may cause an overwhelming infection without
much localization(septicemia),or may get predominantly
localized
to the lung(pneumonia) or the meninges(meningitis).
Systemic bacterial infections are nown by the
generic term neonatal sepsis whichincorporate
septicemia,pneumonia and meningitis of the newborn.
Incidence
In developed countries,the incidence is between !"
!#$!### in term infants and more
fre%uent in preterm infants.In developing countries,the
incidence of both groups(term and
preterm infants) is higher.Neonatal infections
canbeminor or life threatening ma&or infection.
Causes
'ost cases of neonatal sepsis in the community are caused
by (scherichia coli and Staphylococcus aureus.
Types Of Neonatal Sepsis
Neonatal sepsis can be divided into two sub"types
depending upon whether the onset of symptoms is before
)* hours of life(early onset) or later(late onset).
1 . Early onset:
(arly onset infections are caused by organisms prevalent
in the maternal genital tract or in the delivery area. +he
predisposing factors for early onset sepsis include low birth
weight, prolonged rupture of membranes, foul smelling
li%uor, multiple per vaginum e,aminations, maternal fever
difficult or prolonged labor and aspiration of meconium.
(arly onset sepsis manifests fre%uently as pneumonia and
less commonly as septicemia or meningitis.
*.-ate onset.
-ate onset septicemia is caused by the organisms
thriving in the e,ternal environments of the home or the
hospital.+he infection is oftentransmitted through the
hands of the care"providers.+he onset of symptoms is
usually delayed beyond )* hours after birth and the
presentation is that of septicemia, pneumonia or meningitis.
+he predisposing causes of late onset sepsis include, low
birth weight ,lac of breast"feeding, superficial infections
(pyoderma, umbilical sepsis),aspiration of eeds,disruption
of sin integrity with needle prics and use of intravenous
fluids. +hese factors enhance the chances of entry of
organisms into the body systems of the neonates who are
much less immuno"competent as compared to older
children and adults.

Signs sy!pto!s
!. -ethargy
*. /efusal to suc
0. Not arousable, comatose .
1. 2istension abdomen, shoc , bleeding ,renal
failure, cyanosis, tachycardia , grunt,
apnea$gasping ,fever, seizures, blan loo, high
pitched cry.
3. (,cessive crying$irritability
4. 2iarrhea, vomiting
). Nec retraction, bulging fontanel.
5. 6ypothermia.
7. 8oor perfusion, sclerema
!#. 8oor weight gain, e,cessive &aundice.
!!. 8oor neonatal refle,
Diagnostic In"estigation
No investigation is re%uired as a prere%uisite to start
treatment in a clinically
obvious case.(arly treatment is of critical importance.s
!. 6istory taing
*. 8hysical e,amination
0. -aborers tests as W9:, /outine 9lood too.
1. :hest"ray
Treat!ent
Institution of prompt treatment is essential for
ensuring optimum outcome of neonates with sepsis who
often reach the health care facilities late and in a critical
condition. Supportive care and antibiotics therapy are the
two e%ually important component of treatment. It should be
realized that antibiotics tae at least !* to *1 hours to show
any effect and it is the supportive care that maes the
difference between life and death early in the hospital
course.
Supportive care of a sic septic Neonate.
Treat!ent
!. 9ed rest
*. ;,ygen therapy
0. 8rovide warmth, ensure consistently normal
temperature
1. Start intravenous line.
3. Infuse normal saine !#ml$g over 3"!# minutes, if
perfusionis poor as evidenced by capillary refill time
of more than 0 seconds ./epeat the same dose !"*
times over the ne,t 0#"13 minutes, if perfusion
continues to be poor.
4. Infuse glucose!#< *ml$g start.
). In&ect vitamins !mg I'.
5. 8rovide gentle physical stimulation if a panic
7. =void e,ternal feeding if very sic, give maintenance
fluids intravenously
!#. Some time e,change transfusion, if necessary.
Ant#iotic T$erapy
=ntibiotic therapy should cover the common
causative bacteria, namely , (scherichia coli ,
staphylococcus auras and lebsiella pneumonia. =
combination of ampicillin and >entamycin is
recommended for treatment of sepsis and pneumonia. In
case of suspected meningitis, chloramphenicol should be
added.+he antibiotic treatment of non"responsive or
hospital ac%uired sepsis may include amiacine and third
generationcephalosporins such as cefota,ime , ceftazidime.
!.Septicemia or pneumonia.
" In&.=mpicillin 3#mg$ g$dose 5 hourly or !* hourly,

I?,)"!# days.
" In&.>entamycin *.3mg$g$dose!* hourly,I?,)"!# days.
*. 'eningitis. "
" In&.=mpicillin !##mg$g$dose 5hourly or !* hourly,I?"0
wees.
" In&. >entamycin *.3mg$g$dose
5hourly or !*hourly,I?,
wees.
" In&. chloramphenicol !#mg$g
$dose !* hourly I?, 0 wees.
Nursing %anage!ent
!. @eep the patient full bed rest.
*. 'aintain temperature if high grade fever is present.
0. Increase humidity A environmental coolness
1. 8revent from further infection.
3. 2ecrease stimulation to promote rest.
4. =dminister o,ygen
). 8romotion of comfortable position
5. 8revention of e,coriation of sin.
7. 8romote rest A isolation Bprovide rest *1 hour after
fever subside, provide separate bed to prevent spread
to other family members, encourage hand washing
before A after having contact with child
!# . 'onitor vital signs fre%uently.
!!. 'onitor intae and output of the patient.
Co!plications
!. Septicemia
*. 'eningitis
0. 8neumonia
1. =cute renal failure
3. shoc
4. 2eath
). 9leeding
Pre"ention &ro! Infection
!. 'inimum handling of the newborn baby.
*. (,clusion of persons harboring infections including
carriers, from the physical area and facilities of the care of
the newborn.
0. 8roper cleaning of the nurseries and neonatal ward.
1. Washing of hands and forearms under running water,
before and after a baby is handled by the attendant or nurse.
3. Cse of sterile gowns before entering the nursery and
handling the baby.
4. Cse of separate or preferable disposable its for babies.
). 8roper cleaning and washing of babies. :ots and
incubators should be washed with soap and water and
sterilized with one percent cetrimide solution and ! in 5#<
solution of hydrochloride.
5. (ncouragement of breast feeding.