SEPSIS NEONATORUM

A case study presented to our

Clinical Instructor
Ms. Myrna Jalbuena

In partial fulfillment of the requirements for

RLE

Members:
Garate, Aubrey
Pabillar, Andrea Shane M.
Piñon, Mark Laurence V.

Clinical Instructor
Ms. Myrna Jalbuena

Area of Exposure
MCDGH - NICU

Date and Time of Exposure

March 25-26, April 01-02 ; 6:00AM - 6:00PM
 I. Disease Overview

Sepsis neonatorum is a serious bacterial infection that occurs in newborns,

usually within the first week of life. It is a leading cause of morbidity and mortality in
neonates, particularly in premature infants and those with underlying medical
conditions. The condition is caused by bacteria that enter the baby's bloodstream and
spread throughout the body, causing inflammation and organ damage.

The signs and symptoms of sepsis neonatorum can vary, but often include fever
or low body temperature, lethargy, poor feeding, rapid breathing, and a high heart rate.
Diagnosis is typically made through blood tests and cultures to identify the bacteria
causing the infection.

Treatment for sepsis neonatorum involves prompt administration of antibiotics to

target the specific bacterial infection. In severe cases, the baby may require
hospitalization and supportive care, such as oxygen therapy or mechanical ventilation.
Prevention strategies, such as good hygiene practices and appropriate use of antibiotics
during labor and delivery, can help reduce the risk of sepsis neonatorum.

PREDISPOSING
● Low Apgar score (< 6 at 1 or 5
minutes)
● Poor prenatal care.
● Poor maternal nutrition.
● Low socioeconomic status.
● Black mother.
● History of recurrent abortion.
● Maternal substance abuse.
● Low birth weight.
PRECIPITATING
● fetal distress
● maternal pyrexia (> 38 C) or overt
● infection such as a UTI,
● gastroenteritis/diarrhoeal illness
● multiple obstetric procedures including
cervical sutures. preterm delivery.
 II. Patient’s Profile

Patients Name: Baby Boy

Age: 6D
Gender: Male
Address: xxx
Date of Birth: March 21,2021
Admitting Dx: NB,CS
Final Dx: Sepsis Neonatorum
Date of Admission: March 21,2023
Body Weight: 1300 grams
Chest Circumference: 24.8 cm
Head Circumference: 29 cm
Abdominal Circumference: 22 cm
AOG: 31-32 weeks

III. Present Medical History and Present Illness

Present Illness

Sepsis Neonatorum

Maternal gestational age of 31 - 32 weeks suggested as preterm. Newborn with anthropometric

measurement of 29 cm head circumference (normal head circumference 32-33) and 24 cm
chest circumference (normal chest circumference 30-33 cm). Gestational weight is lower than
normal (1,300 grams). Neuromuscular scoring of 11 at 31 – 32 weeks (15). Apgar scored 6 in
the 1st minute of life, and a score of 8 after 5 minutes. Administered medications and laboratory
works. Resulting the following:

Hematocrit – 48 (lower than normal) = 50 - 58

RBC – 4.24 (lower than normal) = 5.0 – 7.0

Higher MCV, MCH, and RDW of 114.60, 33.70, 19.10 respectively = 79.0 – 92.2, 25.7 – 32.2,
11.6 – 14.4

WBC at March 21, 2023 – 27.84 (higher than normal) = 10.0 – 20.0

WBC at March 24, 2023 – 30.87 (higher than normal) = 10.0 – 20.0

Low sodium of 133.0 = 137 – 145

Low pH level of 7.38 = 7.35 – 7.45

Lab Results confirmed the diagnosis of sepsis neonatorum.

Past Medical History

Mother suffered from Gestational Diabetes Mellitus, Preeclampsia with severe features,
Impending Eclampsia, HELLP Syndrome.

IV. Physical Assessment

BODY PART METHOD NORMAL FINDINGS INTERPRETATION

ASSESSMENT

HEAD Inspection 32 - 33 cm head 29 cm head Abnormal

circumference circumference

EYES Inspection No presence of No presence of Normal

coloboma coloboma
 EARS Inspection Presence of With presence of Normal
external ear external ear
meatus meatus
(opening) (opening)

Inspection Top of pinna The top of pinna Normal

must be in line is in line with the
with the outer outer canthus of
canthus of the the eye
eye

NOSE Inspection Without nasal Nasal Flaring Abnormal

flaring can be seen

MOUTH Inspection No blood Coffee Grounds Abnormal

secretions

CHEST Inspection Eupnea Tachypnea Abnormal

Inspection 30 - 33 cm chest 24 cm chest Abnormal

circumference circumference

Auscultation 140 - 160 bpm 167 bpm Abnormal

ABDOMEN Inspection Full and well Retraction Abnormal

rounded

EXTREMITIES Inspection active motion some flexion of Abnormal

the extremities
 Inspection Pinkish Acrocyanosis Abnormal

SKIN Inspection Pinkish Cyanosis Abnormal

V. Anatomy and Physiology (Organ Involved)

Sepsis neonatorum, also known as neonatal sepsis, is a systemic bacterial

infection that occurs in newborn infants. It is a serious medical condition that requires
prompt diagnosis and treatment. The organs and systems involved in sepsis
neonatorum include the bloodstream, lungs, heart, brain, kidneys, and liver.

The infection can spread quickly throughout the body, leading to multiple organ
failure and potentially life-threatening complications.

Lungs - Your lungs are sponge-like organs. Every time you breathe they filter
oxygen from the air through tiny vessels into your blood. The blood is then carried to the
heart to be pumped around your body. When you breathe out, your lungs also filter
carbon dioxide from your body.
 Liver - Your liver is an organ below your lungs. It acts like a filter for the blood.
Chemicals and impurities are filtered by the liver, including from drugs and medications.
The liver does many other essential jobs. For example, it makes and processes many
body fats. The liver is the only internal organ that can regrow.

Kidneys - Your kidneys are also filters. Some drugs are filtered more by the
kidneys than by the liver. Waste products filtered by the kidneys leave the body as urine.

Heart - Your heart is at the front of your chest on your left hand side. It is
between the two lungs. The heart muscles pump blood around your body. You know
your heart is working because you can feel your heartbeat and you can feel the blood at
your pulse.

The Brain is a complex organ that controls thought, memory, emotion, touch,
motor skills, vision, breathing, temperature, hunger and every process that regulates our
body. Together, the brain and spinal cord that extends from it make up the central
nervous system, or CNS.

Bloodstream is transporting oxygen and nutrients to the lungs and tissues.

forming blood clots to prevent excess blood loss. carrying cells and antibodies that fight
infection. bringing waste products to the kidneys and liver, which filter and clean the
blood.

VI. Pathophysiology
SEPSIS NEONATORUM

Caused by a bacterial, viral, or fungal infection that enters a newborn's bloodstream.

Modifiable Non-Modifiable
-inadequate prenatal care -Prematurity
-lack of maternal immunization -low birth weight
-Immunocompromised -Family history
- GDM
 Maternal Infection (UTI)

Entry of bacterial pathogens into the newborn's bloodstream.

triggers of immune response

predisposed to infection

Manifesting signs and symptoms of neonatal sepsis (DOB, Clammy and pale
skin, Hypoxemia)

DOB, Clammy and pale skin, Hypoxemia, affected by food intake, and
Delayed development

SEPSIS NEONATORUM
VII. Diagnostic Procedures

Result Laboratory of Reference Values Actual Results Interpretation

Diagnostic Procedure

ABO TYPING Blood Type: AB

March 24, 2023 Rh: POSITIVE

RBS 50-110 mg/dL Above normal

March 20, 2023 189, 172, 212, 218
March 21, 2023 196, 223, 225 Neonatal
March 22, 2023 94, 122, 226, 168, 259 hyperglycemia

CBC
X-RAY
 VIII. Drug Study

MEDS CLASSIFICATION MECHANISM INDICATION SIDE ADVERSE NURSING

RESPONSIBILITIES
OF ACTION EFFECTS EFFECTS
Ampicillin Antibiotic
are treat nausea, serious allergic Monitor signs
interference certain vomiting, reaction, of allergic
with cell wall infections stomach including: rash, reactions and
synthesis by pain, itching/swelling anaphylaxis,
attachment to diarrhea; (especially of including
penicillin-bind rash; the pulmonary
ing proteins swollen, face/tongue/thro symptoms
(PBPs), black, or at), severe (tightness in
inhibition of "hairy" dizziness, the throat and
cell wall tongue; or. trouble chest,
peptidoglyca breathing wheezing,
n synthesis vaginal cough
and itching or dyspnea) or
inactivation of discharge skin reactions
inhibitors to (rash, pruritus,
autolytic urticaria)
enzymes.

Sodium Alkalinizing increasing metabolic feeling Metabolic Keep sodium

bicarbonate Agents plasma acidosis thirsty, alkalosis. bicarbonate
bicarbonate which may stomach ampules handy
levels, which occur in cramps, and for emergency
Headache.
severe renal administration.
are known to gas Muscle pain and
 buffer excess disease, twitching. Monitor vital
hydrogen ion uncontrolled signs,
concentration diabetes, laboratory
Nausea or
, thereby circulatory results and
vomiting.
insufficiency
raising level of
due to
solution pH shock or Bradypnea. consciousness
to combat severe frequently.
clinical dehydration, Watch out for
manifestations extracorporeal
Nervousness or signs of
circulation of restlessness.
of acidosis. decreasing
blood, level of
cardiac Unpleasant taste. consciousness
arrest and
Record intake
severe
primary Increased and output
lactic frequency in accurately to
acidosis urination monitor renal
function

D10W Glucose-Elevating oxidation to requires Bluish color. Hyperglycemia continually

Agents carbon parenteral changes in and monitor the
dioxide and nutrition skin color. hyperosmolar patient's fluid
water, and hyperglycemic and electrolyte
quickly state status to
provides fluid fast or slow evaluate the
and calories heartbeat. Hypersensitivity effectiveness
Reactions: of the infusion
pain, anaphylaxis, and to avoid
redness, pale pruritus, potential
skin, or bronchospasm, complications
infection at cyanosis, of fluid
the site of angioedema, overload and
injection. hypotension, electrolyte
pyrexia, chills, imbalance
and rash
pains in the
chest, groin,
or legs,
especially
calves of the
legs.

rapid
breathing.
 severe
headaches of
sudden
onset.

shortness of
breath

Meropenem Antibiotic binding to Gram-positive Bluish lips or headache. Observe for

penicillin-bind and skin signs of renal,
ing proteins Gram-negative
diarrhea. hepatic, or
(PBPs) in the infections chills
hematological
bacterial cell
wall and cold, clammy constipation. dysfunction.
inhibiting skin Observe for
peptidoglycan nausea. skin rashes.
cross-linking confusion Measure urine
vomiting.
associated output
with cell wall dizziness pain.
synthesis,
which fainting redness, pain,
ultimately or swelling at
leads to cell fast heartbeat the injection
death site.
fast, weak
pulse
tingling or
pricking
fever
sensation
itching, skin
rash

lightheadedn
ess

rapid, shallow
breathing

Amikacin Aminoglycoside binds to the 30 short-term Nausea, numbness/tingli Monitor for and
 Antibiotic S bacterial treatment vomiting, ng, muscle report auditory
ribosome of serious stomach twitching or symptoms
subunit, infections upset, or loss weakness, (tinnitus,
resulting in of appetite seizure roaring noises,
interfdfjm sensation of
erence with a fullness in ears,
reading of the hearing loss)
genetic code and vestibular
and inhibition disturbances
of protein (dizziness or
synthesis, e.g., vertigo,
elicits nystagmus,
premature ataxia). Monitor
protein & report any
termination changes in
and I&O, oliguria,
incorporation hematuria, or
of incorrect cloudy urine
amino acid

Ranitidine Histamine a competitive prevention Hypersensitivity Administer

H2-receptor inhibitor of of ulcers nausea, reactions, oral drug with
antagonist histamine of the vomiting, anaphylaxis meals and at
H2-receptors. stomach stomach pain; Malaise, dizziness, bedtime.
or somnolence,
The reversible and
insomnia, vertigo,
inhibition of intestines mental confusion,
Decrease
H2-receptors and Doses in renal
diarrhea, agitation, and
in gastric treatment and liver
constipation hallucinations
parietal cells of failure.
results in a gastroeso
reduction in phageal Provide
both gastric reflux concurrent
acid volume disease antacid
and therapy to
concentration relieve pain.

Administer IM
dose
undiluted,
deep into
large muscle
group.

Arrange for
regular
follow-up,
including
 blood tests, to
evaluate
effects

Aminophylline Bronchodilators rapidly and relief of Chest pain or Nausea/vomiting, monitoring

completely bronchos discomfort. stomach/abdomin for CNS
absorbed by pasm al pain, headache, effects,
the body and trouble sleeping, respiratory
fast, slow, or
diarrhea, irritability,
converted to irregular rate, arterial
restlessness,
theophylline heartbeat.
nervousness,
blood
shaking, or gasses, and
increase in increased serum
urine volume. urination theophylline
concentrations

lightheadedness.

persistent
vomiting.

pounding or
rapid pulse.

shakiness

Furosemide Loop Diuretics makes your treatment Peeing more increased Assess fluid
body get rid of of edema than normal. urination and status.
extra fluid associated This will last for sodium loss Monitor daily
through your with about 6 hours weight, intake
congestive after taking and output
kidneys. A
furosemide. ... ratios,
loop diuretic heart
amount and
works on a failure, location of
specific part cirrhosis Feeling thirsty.
edema, lung
of the kidney of the It's important not
sounds, skin
called the liver, and to get
turgor, and
renal dehydrated, but
loop of Henle mucous
how much you
to increase disease, membranes.
drink will
the salt and including Notify health
depend on why
water you pee the care
you're taking
out nephrotic professional if
furosemide. ...
syndrome thirst, dry
mouth,
 Dry mouth. ... lethargy,
weakness,
hypotension,
Headaches. ...
or oliguria
Feeling occurs.
confused or Monitor BP
dizzy and pulse
before and
Feeling or being during
administration
sick (nausea or
vomiting)

PNSS Crystalloid Fluid inducing diuresis given Redness, pain, Bluish color. assessing an
depending on or swelling at IV site.
intravenously changes in skin
the clinical
condition of the
in case of the injection color.
patient shock, site fast or slow calculating IV
dehydration, heartbeat. rates.
and
diarrhea pain, redness, pale monitoring
to skin, or infection at the
increase the site of effectivenes
the injection. s of IV
plasma therapy.
volume rapid breathing.
severe headaches
of sudden onset.

shortness of
breath

IX. NCP

Assessment Nursing Planning Intervention Rationale Evaluation

Diagnosis

Objective: Risk for infection After 8 hours of INDEPENDENT: To have After 8 hours of
related to nursing Monitor V/S baseline data nursing
Increase wbc compromised interventions the Monitor intervention the
with a result of immune system patient will neonates To determine patient will
30.87 achieve timely condition the need for achieve timely
 Risk for resolution of Ensure that all intervention and resolution of
Pre-term birth thermoregulatio current infection equipment uses the current infection
31-32wks n alteration for infants is effectiveness of
related to stress After a week of sterile the therapy After a week of
Increase RR of infection, nursing DEPENDENT: nursing
unstable intervention the Wash hands Reduces risk of intervention, the
VS taken as temperature patient will be before and after cause of patient will be
follows: control fully healed and each activity contamination fully healed and
COLLABORATIVE:
free from further free from further
T - 36 Risk for volume infection Administer To prevent infection
HR - 166 deficit related to antipyretics as further spread of
RR - 67 increased ordered infection Goal met.
O2 sat - 98 metabolic rate,
and insensible Prevents
fluid loss introduction of
bacteria,
reducing risk of
nosocomial
infection.

Assessment Nursing Planning Intervention Rationale Evaluation

Diagnosis

Objective: Fluid volume Short-term: 1. Monitor and 1. To note for the The patient shall
deficit related to record vital signs alterations inV/S be able to
failure of After 3 hours of (decreased BP, maintain fluid
- decreased urine regulatory nursing Increased in PR volume at
output mechanism intervention the and temp) functional level as
patient will be evidenced by
-increased urine Fluid volume able to maintain 2. Note for the 2. To assess what individually
concentration deficit, fluid volume at causative factors factor contributes adequate urinary
hypokalemia,occu functional level as that contribute to to fluid volume output with
-increased pulse rs from a loss of evidenced by fluid volume deficit that may be normal specific
rate(above 160 body fluid or the individually deficit given prompt gravity, stable
bpm)- increased shift of fluids into adequate urinary intervention. vital signs, moist
body the third space output with mucous
temperature(abov one factor normal specific 3. Provide TSB if 3. To decrease membranes,good
e 36 includes a failure gravity, stable patient has fever temperature and skin turgor and
o of the regulatory vital signs, moist provide comfort prompt capillary
C)- decreased mechanism of the mucous refill and
skin turgor- dry newborn membranes,good 4. Provide oral 4. To prevent resolution of
skin/mucous specifically skin turgor and care by injury from edema.
membranes- hyperthermia prompt capillary moistening lips & dryness
elevated hct refill and skin care
resolution of
 edema. 5. Administer IV 5. replaces fluid
fluid replacement loss
Long Term: as ordered
After a couple of
days the patient 6.Administer 6. to reduce body
will still be able to antipyretic drugs if temperature.
maintain fluid the patient has a
volume at fever as ordered.
functional level as
evidenced by
individually
adequate urinary
output with
normal specific
gravity, stable
vital signs, moist
mucous
membranes,good
skin turgor and
prompt capillary
refill and
resolution of
edema.

Assessment Nursing Planning Intervention Rationale Evaluation

Diagnosis

Objectives: Ineffective tissue After 3 hours of Independent 1. To determine Goal met

perfusion related nursing 1. Monitor the the need for evidenced by
to changes intervention the neonate's intervention and peripheral pulses
Age: 31-32wks invenous patient will condition. the effectiveness increase
bloodflow as demonstrate of therapy.
Tachycardia evidenced by increased
impaired perfusion as 2. To have a
hemoglobin(<7g/d transport of evidenced by 2. Monitor Vital baseline data.
L) oxygen. strong peripheral signs.
pulses. 3. To assess
bounding pulses, 3. Note the pulse that may
weak pulse quality and become weak or
strength of thready, because
skin or peripheral pulses. of sustained
temperature hypoxemia.
changes
4. To note for an
increased
Edema 4.Assess respiration that
respiratory rate, occurs in
 depth, and quality response to direct
Inadequateurine effects of
output endotoxins on the
respiratory center
in the brain, as
Heart weakness well as
developing
hypoxia, stress.
Respirations can
become shallow
as respiratory
insufficiency
develops creating
risk of acute
respiratory failure.

5. To assess for
compensatory
5. Assess skin for mechanisms of
changes in color, vasodilation
temperature
andmoisture 6. To
promotecirculatio
6. Elevate Head n/venous
of bed drainage

7. Provide a quite 7.Conservesener

atmosphere gy and lowersO2
demand
Dependent
1. Administer 1.To maximizeO2
oxygen as availability for
ordered cellular uptake

2. Administer 2. drug use

medications with toimprove tissue
caution perfusion

X. Discharge Planning

MEDICATIO EXERCISE/A TREATMENT HEALTH OUTPATIENT DIET SPIRITUAL

N CTIVITY TEACHING FOLLOW UP

Advise Administering Educate parents Schedule a Advise Discuss with

Ampicillin: parents on Antibiotics: on signs and follow-up parents on parents their
50-100 appropriate Antibiotics are symptoms of appointment appropriate spiritual or
mg/kg/dose physical the primary sepsis with a feeding religious
intravenously activities for treatment for neonatorum, pediatrician practices, beliefs, and
(IV) every 12 their sepsis including fever, within 1-2 including provide
hours. newborn, neonatorum. lethargy, and weeks after frequency support as
based on the poor feeding. discharge. and amount appropriate.
Gentamicin: infant's age Fluid of formula or
4-5 and Management: Provide Instruct breast milk. Offer
mg/kg/day condition. Infants with guidance on parents to resources
intravenously sepsis how to care for monitor their Provide for pastoral
(IV) in two Recommend neonatorum their newborn, infant's health guidance on care or
divided gentle may require including closely and how to counseling if
doses. stretching intravenous feeding, bathing, seek medical introduce needed.
exercises to (IV) fluids to and changing attention if any solid foods
Cefotaxime: improve maintain diapers. concerning once the
50 to 100 flexibility and adequate symptoms infant is
mg/kg/dose promote hydration and Discuss the arise. ready.
every 8 to 12 healthy electrolyte importance of
hours. development. balance. proper hand
hygiene to
Oxygen prevent the
Therapy: spread of
Oxygen infection.
therapy may
be required if
the infant is Immunization:
having Educate parents
difficulty on the
breathing or if importance of
there is a immunization to
decrease in prevent other
oxygen infectious
saturation diseases in the
levels. future.

Nutrition and Provide

Feeding: guidance on
Infants with appropriate
sepsis feeding
neonatorum practices, such
may have as the frequency
difficulty and amount of
feeding or formula or
may require breast milk.
specialized
feeding
regimens.
X. Nursing Theory

Roy's Adaptation Model is a nursing theory that emphasizes the importance of

promoting patient adaptation to internal and external stimuli, through assessing the
patient's adaptive responses, identifying factors that interfere with adaptation, and
implementing interventions to promote adaptation.

In the case of a newborn patient with sepsis neonatorum, the nurse's role is to
assess the infant's adaptive responses to the infection and provide interventions that
promote adaptation. The nurse will need to closely monitor the infant's vital signs,
laboratory values, and clinical manifestations of sepsis, such as fever, lethargy, poor
feeding, and respiratory distress.

By applying the Adaptation Model of Nursing, the nurse can assess the newborn
patient's adaptive responses to sepsis neonatorum, implement interventions that
promote adaptation, and involve the parents in the care of the infant. This approach can
help to achieve optimal health outcomes for the newborn patient and promote a positive
experience for the family.

The Conservation Model of Nursing, developed by Myra Levine This model

emphasizes the importance of balancing the patient's need for conservation
(preservation of energy and resources) with the patient's need for restoration (regaining
health and well-being). In the case of a newborn patient with sepsis neonatorum, the
nurse can apply this theory by balancing the infant's need for rest and recovery with the
need for medical interventions and supportive care.

In the case of neonates with sepsis neonatorum, the nurse can apply the
Conservation Model of Nursing by assessing the infant's energy and resource
conservation needs while also providing interventions that promote recovery and
healing. For example, the nurse can minimize unnecessary stimulation and provide a
quiet, calm environment to help the infant conserve energy. The nurse can also provide
supportive care, such as administering antibiotics and fluids, to help the infant restore
health and well-being.

Additionally, the Conservation Model of Nursing emphasizes the importance of

assessing the patient's response to interventions and adjusting care as needed. In the
case of neonates with sepsis neonatorum, the nurse must closely monitor the infant's
response to interventions, such as vital signs, laboratory values, and clinical
manifestations of sepsis. The nurse can then adjust care interventions based on the
infant's response to promote optimal health outcomes.

Disease Overview Book Reference:

Silbert-Flagg, J. & Pillitteri, A. (2020). Maternal and Child Health Nursing: Care of the
Childbearing and Childrearing Family, 8th Edition, Volume 2. Wolters Kluwer.