NEONATOLOGI

Sepsis Neonatorum
 Initial signs and symptoms of infection in newborn infants

General Fever, temperature instability, “not doing well”, poor feeding,

or edema
CNS Irritability, lethargy, tremors, seizures, hyporeflexia, hypotonia,
abnormal Moro reflex, irregular respiration, full fontanel, or
high-pitched cry
Cardiovascular system Pallor, mottling, cold, clammy skin, tachycardia, hypotension, or
bradycardia
Respiratory system Apnea, dyspnea, tachypnea, retractions, flaring, grunting, or
cyanosis
Gastrointestinal system Abdominal distention, vomiting, diarrhea, or hepatomegaly
Renal system Oliguria

Hematological system Jaundice, splenomegaly, pallor, petechiae, purpura, or bleeding

 Hematological Scoring System
Criteria Abnormality Score
Total WBC count ≤5,000/μl 1
≥25,000 at birth 1
≥30,000-12-24 h
≥21,000-Day 2 onward
Total PMN count No mature PMN seen 2
Increased/decreased 1
Immature PMN count Increased 1
I:T PMN ratio Increased 1
I:M PMN ratio ≥0.3 1
Degenerative changes in PMN Toxic granules/cytoplasmic vacioles 1
Platelet count ≤150,000/μl 1
The normal values are
Total PMN count-1800-5400 Immature PMN count-600 Immature: Total PMN ratio-
0.120 Immature: Mature PMN ratio-≥0.3
Rodwell et all. The Journal of pediatrics . 1988; 112(5): 761-5
Interpretation of Hematological Scoring System

Score Interpretation
≤2 Sepsis is unlikely
3 or 4 Sepsis is possible
≥5 Sepsis or infection is very likely

Narasimba A, Kumar M. L. H. Indian J Hematol Blood Transfus. 2011;27(1):14-7

 Performance of Individual Hematological Findings
Positive Negative
Sensitivity (%) Specificity (%) predictive value predictive value
(PPV) (%) (NPV) (%)
Total WBC count 10.52 91.66 80 24.44
Total PMN count 89.47 8.33 75.55 20
I PMN count 78.94 8.3 73.17 11.11
I:T PMN ratio 63.15 75 88.88 39.13
I:M PMN ratio 73.68 50 82.35 37.5
Degenerative 68.42 66.66 66.66 40
changes
Platelet count 47.36 75 85.71 31

Narasimba A, Kumar M. L. H. Indian J Hematol Blood Transfus. 2011;27(1):14-7

 TRANSIENT TACHYPNEA OF THE NEWBORN

• On term and late preterm infants related to

delayed clearance of lung liquid.
• Appears shortly after birth (first 6 hours),
resolves within 3-5 days.
• Tachypnea (>60 breaths/min), retractions,
grunting, requirement for supplemental
oxygen.

Gomella TL, Cunningham MD, Eyal FG. Neonatology. 7th edition. 2013: 919-925
Guglani L, Lakshminrusimha S, Ryan RM. Transient tachypnea
of the newborn. Peds in Rev. 2008;29;e59
Chest x-ray: hyperinflation, congestion, perihilar streaking, fluid in the
interlobar fissure, flattening of the diaphragm.
Differential
Diagnosis of
TTN

TTN is often a
diagnosis of
exclusion, other
causes should be
excluded first.

Guglani L, Lakshminrusimha S, Ryan RM. Transient tachypnea of the newborn. Peds in Rev. 2008;29;e59
 MANAGEMENT
PREVENTIVE
• Elective Caesarean Section
scheduled at gestational age of
≥39weeks. Vaginal births
appears to be protective.
• Antenatal betamethasone prior
to elective CS at term.
• Prevent low Apgar scores.
THERAPY
• Oxygenation
• Thermoregulation
• Enteral feeding or IV if indicated.
• Inhaled epinephrine (?)
• 2-Agonist salbutamol (?)
Gomella TL, Cunningham MD, Eyal FG. Neonatology. 7th edition. 2013: 919-925
 NEONATAL PNEUMONIA
EARLY ONSET OR INTRAUTERINE PNEUMONIA LATE ONSET OR NOSOCOMIAL PNEUMONIA
• Onset within 48h of birth • Onset > 48 h after birth
• 70% due to Group B Streptococcus • Common in ventilated babies
• Other causes: HiB, E. coli, S. pneumoniae, K. (VAP)
pneumoniae, Listeria monocytogenes. Chlamydia
trachomatis, Viruses (CMV, HSV), Candida albicans. • Causes: Gram-negative bacilli +
• Associated with Pre-Labour rupture of membranes Staph. Aureus, S. epidermidis,
(PROM) & evidence of chorioamnionitis. RSV, fungi and mycoplasma
• In preterm: presents as RDS, may produce focal • Treatment: broad spectrum
opacities on CXR.
antibiotics
• In term: presents with signs of respiratory distress,
PPHN common. • Lung abscess is rare
• Treatment: respiratory support and antibiotics complication
(Ampicillin + Gentamicin; Amoxicillin for Listeria)

Fox G, Hoque N, Watts T. Oxford Handbook of Neonatology. 2nd Edition. 2017. p.115
Neonatal pneumonia. Note the right upper lobar Neonatal pneumonia. Diffuse increase in
consolidation (arrow). interstitial lung markings.

Warren JB, Andersen JM. Newborn Respiratory Disorders. Peds in Rev. 2010;31;487
Gomella TL, Cunningham MD, Eyal FG. Neonatology. 7th edition. 2013: 919-925