COMMON NEONATAL

DISORDERS
AND ITS MANAGEMENT
NEONATAL SEPSIS
 INTRODUCTION
• Neonatal sepsis or sepsis neonatrum or neonatal
septicaemia occurs when pathogenic bacteria gain
access into the blood stream. They may cause an
overwhelming infection (septicaemia) or localize into
lungs causing pneumonia or into meninges causing
meningitis.
• Neonatal septicaemia occurs in infants less than 90
days of age. Early onset sepsis is seen in first week of
life.late onset of sepsis occurs after 1 week of age
within 90 days.
 DEFINITION
• Neonatal septicemia is defined as generalized
systemic features of infection,associated with
pure growth of bacteria from one or more
sites,in a newborn.
• It is one of the most important causes of
mortality and morbidity in newborn
•(especially in preterm,LBW babies).
 INCIDENCE
• According to NNPD,
-incidence of neonatal sepsis is about 30 per
1000 live births
-incidence of mortality due to NNS is about 4.1 %
 CLASSIFICATION
Neonatal sepsis can be classified into
two sub-types depending upon time of
onset of symptoms

Before 72 After 72
hours of life hours of life
(early onset (late onset
sepsis) sepsis)
 ETIOLOGY

• A number of different bacteria including E.

coli, listeria and certain strains of
streptococcus may cause neonatal sepsis.
• Early onset neonatal sepsis most often
appears within 24 hours of birth.
 ETIOLOGY CONTD….
• The following increase an infant’s risk of
early onset sepsis:-
– Group B streptococcus infection during
pregnancy
– Preterm delivery and LBW baby
– Infection of placental tissue and amniotic fluid
– Multiple pervaginal examination
– Maternal fever and infection
• Babies with late neonatal sepsis get infected
after delivery by the organism thriving in the
external environment of the home or hospital.
 ETIOLOGY CONTD…..

• The following increase infant’s risk of

developing late onset septicemia.
– Having an intracath in blood vessel for long time.
– Hospital stay for long time.
– Lack of aseptic technique following by care
givers.
– Lack of breast feeding.
– LBW
– Superficial infection ( pyoderma, umbilical
sepsis)
 ETIOLOGY CONTD…..
• Organisms that have been implicated in causing
late- onset sepsis include the following:
– Coagulase-negative Staphylococcus
– Staphylococcus aureus
– E coli
– Klebsiella
– Pseudomonas
– Enterobacter
– Candida
– GBS
– Serratia
– Acinetobacter
– Anaerobes
 RISK FACTORS
• generally well-appearing
• previously healthy
– full term (at ≥37 weeks gestation)
– no antibiotics perinatally
– no unexplained hyperbilirubinemia that required
treatment
– no antibiotics since discharge
– no hospitalizations
– no chronic illness
– discharged at the same time or before the mother
• no evidence of skin, soft tissue, bone, joint, or
ear infection
 CLINICAL FEATURES

• The manifestation of neonatal septicemia

are subtel, vague and non- specific.
• The most common compliant concerning
infant’s progress is “ failure to do well” or “
not looking right”.
• Hypothermia is a common manifestation.
 The signs of sepsis are non-specific and include:

• Body temperature • Seizures

changes • Bradycardia
• Breathing problems • Swollen belly area
• Diarrhea • Vomiting
• Low blood sugar • Yellow skin and whites
• Reduced of the eyes (jaundice)
movements
• Reduced sucking
 Cont… Clinical Feature

• Circulator system • Respiratory system

– Pallor, cyanosis  Irregular

– Cold, clammy skin respiration ,

– Hypotension and apnea,
shock  Cyanosis
– Edema  Grunting
– Bradycardia or  Dyspnea
tachycardia  Retraction
 Cont… Clinical Feature
• Central Nervous • GI system-
System – • Poor feeding
– Reduced activity • Vomiting
• ( lethargy , coma,
• Diarrhea or
poor cry)
– Irritability , tremors
decreased stoolpass
– Full fontanel • Abdominal
distension
– Abnormal eye
movement
• Hepatomegaly
 Cont… Clinical Feature
• Hematopoietic • Feature suggestive of
system- pneumonia include-
– Jaundice • Tachycardia
– Pallor
• Chest retractions
– Ecchymosis
• Early cyanosis
– Spleenomegaly
• Poor feeding
– Bleeding
• Lethargy
 DIAGNOSTIC EVALUATION
• Blood Culture

• Urine examination

• CSF study

• CBC

• C- reactive protein

• ESR may be elevated ( >15 mm 1st hour)

 MANAGEMENT
• For babies with neonatal sepsis,

–Supportive care and

–Antibiotic therapy
 SUPPORTIVE CARE
• Provide warmth
• Start IV line. Infuse normal saline 10ml/kg
over 5 to 10 minute.
• Infuse 10%glucose, 2ml/kg stat to
manage hypoglycemia.
• Administer injection vitamin K, 1mg
IM to prevent bleeding.
• If the baby is cyanosed or grunting
provide oxygen via hood or mask.
 Cont… Supportive care
• If baby is Apneic provide physical stimulation
and bag – mask ventilation, if required.
• Avoid oral feeding if baby is very sick and
given intravenous fluid.
• In neonates with sclerema, exchange
transfusion with fresh whole blood may be
required.
 ANTIBIOTIC THERAPY
• Antibiotic therapy should cover common
causative bacteria like E.coli,
staphylococcus aureus and klebsiella
pneumoniae.
• A combination of ampicillin and gentamycian
is recommended for treatment of sepsis and
pneumonia.
 CONT…ANTIBIOTIC THERAPY

• IN Septicemia and Pneumonia

• Injection Ampicillin 50 mg/kg/dose 12
hourly IV or IM 7 to 10 days
• Injection Gentamicin 2.5mg/kg/dose BD
IV/IM, 7 to 10 days
•In Meningitis
• Injection Ampicillin 100 mg/kg/dose 12
hourly IV 3 weeks
• Injection Gentamicin 2.5mg/kg/dose BD IV,
3Weeks or
• Injection Chloramphenicol 12mg/kg/dose
BD IV, 3weeks
 PROGNOSIS

• The prognosis is variable. Sever neurological

and respiratory problem may occur in low
birth weight babies as a result of early onset
sepsis.
• Late onset sepsis and meningitis may
result in poor outcomes.
PREVENTION