UNIVERSITY OF CAPE COAST

SCHOOL OF BIOLOGICAL SCIENCES

DEPARTMENT OF NURSING

COUSRE CODE: NUR 402

PAEDIATRIC NURSING

ASSIGNMENT ONE (1)

TOPIC:

INFECTIONS OF THE NEWBORN

BY
GROUP TWO (2)

LEVEL: 400

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DATE: OCTOBEER, 2010
GROUP TWO (2)

MEMBERS INDEX NUMBER

1. OKYERE, ERNESTINA APPIAH SC/NUS/07/0004

2. AGYEMAN, NANA AKUA NYANTA SC/NUS/07/0057

3. DARBIE, ERIC EDEM SC/NUS/07/0033

4. BONUEDIE, LUCY AWOYO SC/NUS/08/0083

5. NELSON BUAH, JOSEPHINE SC/NUS/09/0037

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INFECTIONS OF THE NEWBORN
INTRODUCTION

Newborn babies have weak immune systems. This is one reason why breastfeeding is so
important: it provides the newborn baby with antibodies to help fight infection. As a result, breastfed
infants have fewer infections than babies who are bottle fed.

When a newborn baby does develop an infection, it can become a great cause for concern. This is
because newborn babies can get sick very fast. Luckily, they also respond very quickly to
treatment, if the infection is caught in time. If a doctor suspects that a newborn baby has an
infection, he will begin antibiotic treatment right away.

Most infections in newborn babies are caused by bacteria and some by viruses. A mother’s birth
canal contains bacteria, especially if she has an active infection. During childbirth, the baby can
swallow or breathe in the fluid in the birth canal, and bacteria or viruses can get into his lungs and
blood. The baby can become sick during childbirth or within the first few days after birth. As the
bacteria or viruses multiply, the newborn baby can become ill very quickly. The sooner the infection
is discovered and treated, the better the outcomes will be for the newborn baby.

Occasionally, a newborn baby catches an infection after birth from someone who has a cold or flu.

The symptoms of a beginning infection are listed below. It may be difficult at first to determine if the
newborn baby has an infection, because healthy newborn babies can also have some of these
symptoms even though there is no infection. In a newborn baby with an infection, these symptoms
will continue. Assessment by a doctor may include:

 Irregular temperature below 36.6°C (97.9°F) or above 38.0°C (100.4°F), taken rectally

 Poor feeding and difficulty waking to feed

 Excessive sleepiness

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  Irritability

 Rapid breathing at a rate over 60 breaths per minute

 Change in behavior

 As the infection gets worse, the newborn baby may develop additional symptoms:

 difficulty breathing

 bluish tinge around mouth

 pale or grayish skin

 high body temperature (above 38.0°C or 100.4°F, taken rectally)

 low body temperature (under 36.6°C or 97.9°F, taken rectally), despite being wrapped with clothes and blankets

A number of tests can be used to diagnose the infection. However, test results usually take two –
three days to come back, so in the meantime, the doctor will prescribe antibiotics for the newborn
baby while he is waiting for the test results to confirm the diagnosis.

The following tests may be needed to diagnose infection in newborn babies:

Complete blood count : This is when a sample of your newborn baby’s blood is taken. The
complete blood count (CBC) will determine the number of each type of blood cell. Special
attention is focused on the number of white blood cells (WBCs), as these can be abnormal in
number when an infection is present. An abnormal number of WBCs often indicates that the
newborn baby’s body is fighting some sort of infection.

 Blood culture: The blood culture will determine if any bacteria can be grown in the blood. If
bacteria grow in the culture, the baby has an infection in the bloodstream. The results of this test
can take up to 24 hours and sometimes longer, which is why treatment is not delayed
while waiting for the result.
 Urine test: This is when a sample of the newborn baby’s urine is taken to determine its
white cell count and sent away for culture.
 Eye or skin swab: This is when pus or fluid from a possible site of infection, such as the eye
or umbilical cord, is swabbed and sent away for analysis.
 Chest X-ray: A baby need a chest X-ray, if pneumonia is suspected.

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 Spinal tap: A lumbar puncture is also called a spinal tap, and it is necessary if an infection of
the meningitis, is suspected.

Antibiotics are not given to newborn babies by mouth because they are not absorbed very well
from the stomach. The length of time that antibiotics are administered depends on the type of
infection that is being treated. Treatment can range from seven to 21 days. If the test results are
negative, the antibiotics will most likely be discontinued.

Some newborn babies need extra oxygen during this time, especially if they have pneumonia

Some of the common infections of the newborn are:

1. Opthamia Neonatorum or Neonatal Conjunctivitis

2. Pemphigus
3. Oral Candidiasis
4. Cord Sepsis and
5. Neonatal Tetanus

1. OPTHALMIA NEONATORUM

A newborn with gonococcal ophthalmia neonatorum.

Neonatal conjunctivitis, also known as ophthalmia neonatorum, is a form of bacterial

conjuctivitis contracted by newborns during delivery. The baby's eyes are contaminated during
passage through the birth canal from a mother infected with either Neisseria gonorrhea or
Chlamydia trachomatis.

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THE NON INFECTIOUS

Chemical irritants such as silver nitrate can cause chemical conjunctivitis, usually lasting 2–4
days. Thus, silver nitrate is no longer in common use. In most countries, neomycin neomycin and
chloramphenicol chloramphenicol eye drops are used instead.

INFECTIOUS

Many different bacteria and viruses can cause conjunctivitis in the neonate. The two most feared
causes are N. gonorrheae and Chlamydia acquired from the birth canal during delivery.

Ophthalmia neonatorum due to gonococci (Neisseria gonorrhea) typically manifests in the first
five days of life and is associated with marked bilateral purulent discharge and local
inflammation. In contrast, conjunctivitis secondary to infection with chlamydia (Chlamydia
trachomatis) produces conjunctivitis after day three of life, but may occur up to two weeks after
delivery. The discharge is usually more watery in nature (mucopurulent) and less inflamed.
Babies infected with chlamydia may develop pneumonitis (chest infection) at a later stage (range
2 weeks – 19 weeks after delivery). Infants with chlamydia pneumonitis should be treated with
oral erythromycin for 10–14 days.

Other agents causing Opthalmia neonatorum include Herpes simplex virus (HSV2)
Staphylococcus aureus, Streptococcus Haemolyticus andStreptococcus pneumoniae.

CLINICAL FEATURES

1. Pain and tenderness in eyeballs

2. Conjunctival discharge :purulent, mucoid or mucopurulent depending on the cause.
3. Conjunctiva shows hyperaemia and chemosis.
4. Eyelids are usually swollen.

TREATMENT

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Systemic therapy: Neonates with gonococcal ophthalmia neonatorum should be treated for seven
days with one of the following regimens

1. Cefotaxime 100-150mg/kg/dayIVorJM,12hourly

2. Ciprofloxacin 10-20mg/kg/day or Norfloxacin 10mg/kg/day

3. Crystaline benzyl penicillin G 50,000units (for full term normal weight babies) or 20,000
units (for premature or low weight babies) IM twice daily for three days (if penicillin is
susceptible)

 Other bacterial ophthalmia neonatorum should be treated by broad spectrum

antibiotics drops and ointment for two weeks.
 Neonatal inclusion conjunctivitis caused by Chlamydia trachomatis responds well to
topical tetracycline 1% or erythromycin 0.5% eye ointment QID for three weeks.
However systemic erythromycin should also be given since the presence of
chlamydia agents in conjunctiva implies colonization of upper respiratory tract as
well. Both parents should also be treated with systemic erythromycin.
 Herpes simplex conjunctivitis is usually a self-limiting disease. Topical antiviral
drugs control the infection more effectively and may prevent recurrence.

COMPLICATIONS

Untreated cases may develop corneal ulceration, which may perforate resulting in corneal
opacification and Staphyloma formation.

Corneal involvement (rare) may occur in herpes simplex opthalmia neonatorum

If left untreated it can cause blindness.

PREVENTIVE MEASURES
Eyedrops containing erythromycin are typically used to prevent the condition
Prophylaxis needs antenatal, natal and post natal care.

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 1. Antenatal measures include thorough care of mother and treatment of genital
infections when suspected.
2. Natal measures are of utmost importance as mostly infection occurs during
childbirth. Deliveries should be conducted under hygienic conditions taking all
asceptic measures. The newborn baby's closed lids should be thoroughly cleansed
and dried.
3. Postnatal measures include:

1. Use of 1% tetracycline ointment or 0.5% erythromycin ointment or 1% silver nitrate solution

(crede's method) into the eyes of babies immediately after birth 2. Single injection of ceftriaxone
50 mg/kg IM or IV should be given to infants born to mothers with untreated gonococcal
infection. B. Curative treatment as a rule, conjunctival cytology samples and culture sensitivity
swabs should be taken before starting treatment

 Chemical ophthalmia neonatorum is a self-limiting condition and does not require

any treatment.
 Gonococcal ophthalmia neonatorum needs prompt treatment to prevent
complications. Topical therapy should include

1. Saline levarage hourly till the discharge is eliminated 2. Bacitracin eye ointment four
times per day (Because of resistant strains topical penicillin therapy is not reliable.
However in cases with proved penicillin susceptibility, penicillin drops 5000 to 10000
units per ml should be instilled every minute for half an hour, every five minutes for next
half an hour and then half-hourly till infection is controlled) 3. If the cornea is involved
then atropine sulphate ointment should be applied.

2 PEMPHIGUS NEONATORUM

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. A disease of infants due to group 2 phage type 17 staphylococci that produce an epidermolytic
exotoxin. Superficial fine vesicles and bullae form and rupture easily, resulting in loss of large
sheets of epidermis A group of conditions affecting the new born that resembles pemphigus

 . Staphylococcal scalded skin syndrome

 Exfoliative dermatitis
 Toxin-mediated staphylococcal syndromes
 Ritter's disease

CLINICAI FEATURES

 Skin shedding in infants

 Blistered skin in infants
 Red skin in some cases in infants
 Thickening of skin on palms in infants
 Thickening of skin on soles in infants

TREATMENT

 Application of calamine lotion on the blisters to sooth the skin

 Antibiotics when necessary
 Baby should be rehydrated with intravenous fluids, when there are signs of dehydration

PREVENTIVE MEASURES

 Proper personal hygiene

 Use of antiseptic lotions in washing baby’s clothing
 Mother should maintain hand hygiene before and after handling the baby

COMPLICATIONS

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The list of complications that have been mentioned in various sources for Pemphigus
neonatorum includes:

 Infection
 Dehydration
 Steven Johnson Syndrome

3 ORAL CANDIDIASIS

Oral Candidiasis (oral thrush) is a very common problem that can sometimes develop in newborn
babies. Often, the baby may feel irritable and uncomfortable due to the condition. Many people have
candida in their mouth, but our immune system allows us to balance out the candida. Babies are
more susceptible to candida as their immune system have not developed as much as adults.

Oral candida is an infection of yeast fungus, Candida albicans in the mucous membranes of the
mouth. Thrush is only a temporary candida infection in the mouth of babies.

CAUSES

There are many factors which can be attributed to oral thrush in babies and one of the most
common reason is when the candida in the baby’s mouth has increased and cause an infection.
Other causes of oral thrush in babies include:

1. Baby’s immune system is premature and more susceptible to infection

2. Baby is taking medication such as antibiotics whih has reduced bacteria which is
healthy in her body and subsequently allowed the candida to further develop.
3. A mother may pass the candida to her baby if she is breastfeeding and taking
antibiotics
4. If a mother has the thrush herself, and is breastfeeding she could pass it to her baby.
5. If the mother had a vaginal birth and there was thrush present the baby might have
caught it.
CLINICAL FEATURES
6. White/cream or yellow coloured spots in the mouth.
7. Slightly raised spots which are painless.
8. The baby may have trouble sleeping

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 9. The baby may become irritable
10. There may be a milk curd type of white substance on the gum or tongue.

TREATMENT

Nystatin drops may be prescribed

If you're breastfeeding an infant who has oral thrush, you and your baby will benefit if both are
treated. Otherwise, you're likely to pass the infection back and forth. Your doctor may prescribe
Nystatin suspension for your baby and Nystatin Cream for your breasts.

Nystatin is generally squirted into the mouth four times a day. For more stubborn lesions,
Nystatin can be directly applied to the lesions with a cotton swab.

Thrush normally will clear up with in a few weeks. If it does not clear up after two weeks of anti-
fungal treatment, you should notify your health care provider.

PREVENTING ORAL CANDIDIASIS

Tips that may help prevent oral thrush include:

1. Giving baby sterilized water to drink after breastfeeding to rinse any milky residue away.

2. Be sure to clean and sterilize bottles and pacifiers thoroughly and allow to dry.

3. Let your nipples air dry between feedings.

4. Consider supplementing if you know you have taken or need to take a course of antibiotics.

The good news is that oral thrush is rarely serious and can be treated relatively easily when it is
discovered. If you think you or your newborn might be suffering from a oral thrush, be sure to
contact your healthcare provider for an accurate diagnosis before attempting any treatment
methods.

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 4. CORD/UMBILICAL SEPSIS

Infection of the umbilical cord after birth can result from unhygienic methods of cutting the cord
or lack of hygienic care of the umbilical cord stump until it falls off. The umbilical stump needs
to be kept clean and dry until it falls off. The infection from the umbilical cord can in rare cases
spread to other parts of the body and may be fatal if untreated. .

CLINICAL FEATURES

 Red umbilical cord stump

 Swollen umbilical cord stump
 Green or yellow discharge from umbilical cord stump
 Umbilical cord bleeding - a small amount of bleeding without other symptoms may be
normal

CAUSE

The primary cause of Umbilical cord infection is the result:

 of transmission of an infectious disease. Some subtypes of this disease are contagious -

spread easily between people, while other subtypes are infectious - transmitted by a
pathogenic organism.

TREATMENT

 Antibiotics
 Sedatives
 Analgesic

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PREVENTION OF UMBILICAL/CORD INFECTION

Method of prevention of umbilical cord infection mentioned in various sources includes those
listed below. This prevention information is gathered from various sources, and may be
inaccurate or incomplete. None of these methods guarantee prevention of Umbilical cord
infection.

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  Umbilical cord stump hygiene measures - for a week after the stump falls off.
 Rubbing alcohol
 Fold diaper down so that it does not irritate the umbilical cord area
 Avoid tub baths until umbilical cord area is healed - although opinions on this infant
hygiene issue differ.

5. NEONATAL TETANUS

Neonatal tetanus or "tetanus Neonatorum" is a tetanus infection of the newborn baby. The
infection is usually caught from another infected person (e.g. unvaccinated mother) and enters
the body through a wound such as the umbilical stump or the circumcised region.

CLINICAL FEATURES

The list of signs and symptoms mentioned in various sources for Neonatal tetanus includes the 7
symptoms listed below:

 Muscle rigidity
 Irritability
 Dysphasia
 Restlessness
 Facial grimacing
 Muscle spasms
 Poor suck

PRIMARY CAUSE OF NEONATAL TETANUS

The primary cause of Neonatal tetanus is the result:

 of an infectious agent.

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LATEST TREATMENT FOR NEONATAL TETANUS

The following are some of the latest treatments for Neonatal tetanus:

 Prophylactic intubation
 IV fluids
 Succinylcholine
 Benzodiazepines
 Clonidine
 Morphine
 Magnesium
 Fentanyl
 Human tetanus immune globulin
 Metronidazole
 Benztropine
 Doxycycline
 Dopamine
 Erythromycin
 Labetalol
 Diazepam
 Propanolol

PREVENTION OF NEONATAL TETANUS

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Method of prevention of neonatal tetanus mentioned in various sources includes those listed
below. This prevention information is gathered from various sources, and may be inaccurate or
incomplete. None of these methods guarantee prevention of Neonatal tetanus.

 Umbilical cord hygiene

 Circumcision hygiene
 Avoid baby contact with anyone with tetanus
 Maternal vaccination against tetanus

In conclusion it is clear that infection in the newborn can be prevented through effective
personal and environmental hygiene. Further more, with good antenatal and post-natal
care to both the mother and her newborn baby, infection can be prevented.

REFERENCE
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 1. (15th Edition); Edited by Fraser, D. M. & Cooper, A. C.;

MYLES TEXTBOOK FOR MIDWIVES (2009)

Churchill Livingston Elsevier.

Pg (922-924)

2. Daeschner C. W.Jr, &Richardson C.J. (1997)

PAEDIATRICS AN APPROACH TO INDEPENDENT LEARNING

(#rd Edition); The Johns Hopkins University Press, Baltimore and London

3. ^ "MedlinePlus - Neonatal
Conjunctivitis"http://www.nlm.nih.gov/medlineplus/ency/article/001606.htm. Retrieved
2008-08-28.
^ "Conjunctivitis, Neonatal: Overview - eMedicine".
http://emedicine.medscape.com/article/1192190-overview.

^ "Red Book - Report of the Committee on Infectious Diseases, 29th Edition. The American
Academy of Pediatrics.". http://aapredbook.aappublications.org/. Retrieved 2007-07-12.

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