NEONATAL SEPSIS

Dr Khadar: MBBS, FC PEADS, MMED, MPH

Edna University
What is the most common causes of early
onset neonatal sepsis?

 Ans: Group B streptococci

 DEFINITION:

 Neonatal sepsis is a clinical syndrome of systemic illness

accompanied by bacteremia occurring in the first month of
life.
ETIOLOGY

 Group B Streptococci ( Most common)

 Escherichia coli (second most common)
 Coagulase negative staphylococcus aureus.
 Strep.pneumoniae
 Listeria monocytogenes
 Klebsiella pneumoniae
 Classification
 Early Onset (EOS):
 Infection occurring in the first 7 days of life.
 For the continuously hospitalized VLBW (<1500g) infant, its
defined as culture-proven infection occurring at <72 hours
of age.
 Late Onset:
 Occurs 7 days after birth
 For the continuously hospitalized VLBW infant, its defined
as culture-proven infection occurring at >72 hours of age.
 Usually from the external environment.
 Risk factors associated for early-onset sepsis

 Maternal factors:
prolonged rupture of membranes > 18 hours
Foul smelling liquor
Multiple P/V examinations
Maternal fever
difficult or prolonged labour
Meconium aspiration.
Neonatal factors:
Preterm and low birth weight
Perinatal asphyxia
Vigorous resuscitation
Invasive procedures
Congenital malformations ,e.g.
Meningomyelocelle.
The Risk factors associated with late-onset neonatal sepsis

 Lack of hand hygiene by health care givers

 Lack of initiating breast feeding
 Aspiration of feeds
 Low birth weight
 Superficial infections (pyoderma, umbilical sepsis)
 Disruption of skin integrity
 CLINICAL FEATURES
 Fever > 37.5’c or hypothermia < 35.5’c not
responding to warming
 Respiratory problems- Tachypnea, grunting, apnoea
 Lethargy
 Not able to feed
 Irritability
 Vomiting
 Hypotension, poor perfusion with pallor
 Tachycardia or bradycardia
 Abdominal distension
 Jaundice
 Petechiae, purpura and bleeding
 INVESTIGATION

 CBC, CRP
 BLOOD CULTURE
 LUMBER PUNCTURE
 CHEST X RAY
 Treatment
 Start empiric antibiotic treatment if one or
more of the following septic risk factors is
present:
 Maternal invasive bacterial infection requiring
antibiotics (ie suspected or confirmed).
 Confirmed or suspected infection in twin
 Respiratory distress starting more than 4 hrs after birth
 Mechanical ventilation in a term baby
 Seizures
 Signs of shock
 Start empiric antibiotics if two or more
of the following septic risk factors are
present:
 Antenatal:
 Preterm birth following spontaneous labour <36 weeks OR prelabour ROM
 ROM >18hrs
 Maternal fever >38c or chorioamnionitis
 Post natal:
 Altered behavior/tone/responsiveness
 Feeding difficulties (eg: food refusal in a term baby) or intolerance
 Respiratory distress
 Apnea
 Bradycardia or tachycardia
 Hypoglycemia or hyperglycemia
 Metabolic acidosis >10mmol/l
 Temperature abnormality >38c or <36 not explained by environmental factors
 If only one risk factor is present, consider observation for 24hrs
Early onset (<72hrs of live):
 Term baby:
Ampicillin 50mg/kg (12 hrly if <2kg, 8hly if >2kg)
Gentamycin 5mg/kg:
 <1kg; 48 hrly if <2wks old. 24hly if >2wks old
 1-2kg; 48hly if <1wk old. 24hly if >1 week old
 >2kg: 4mg/kg/dose 24hly

 Duration: Usually for 5 days but if severe for 7-10days

Late onset sepsis (>72hrs of live):
The empiric antibiotics is determined by
considering the organisms known to have caused
infection in the unit in the last 6 months.
o Ampicillin plus Cefotaxime (In our unit).
o Meropenem (in SA)
o Vancomycin if at risk for staph aureus sepsis
If MENINGITIS:
Ampicillin plus Cefotaxime.
 Duration: Minimum 2 weeks, ideally 3-4 weeks.
E.coli needs longer treatment, at least 3weeks.
 In late sepsis and/or not improving, signs for
skin/cord infection:
Ampiclox or flucloxacillin and gentamicin
 If signs of kidney failure:
 Give Cefotaxime instead of Gentamycin.
 If the organism is resistant to these antibiotics or the
infant’s condition does not improve:
Consider Vancomycin or Meropenem
Supportive treatment

Treat hypoglycaemia
Paracetamol if very high fever
Feeds/fluids as necessary
Oxygen if needed
Vitamin K
 Prevention
 Wash your hand with soap and water when
entering and leaving the ward
 Use alcohol hand sanitizer before and after you
touch the patient.
 Pull up your the sleeves of your shirt above
elbows
 Remove watch and rings
 UMBILICAL CORD INFECTION

 Umbilicus is swollen, red, draining pus,

or foul smelling
 Treatment:
 Admit if redness >1cm from umbilicus
 Wash the umbilicus with antiseptic
solution or normal saline
 Swab with 0,5% gentian violet four times
daily, diluted povidone iodine, fucidic acid
or mupirocin until infection cleared.
 Give antibiotics:
o Ampiclox inj 50mg/kg (12 hourly first 7
days, if > 7 days 8 hourly)
 Neonatal Conjunctivitis
 Chlamydial:
 Azithromycin (20 mg/kg PO daily)
for a three day.
 Irrigated frequently with saline
 Gonorrhoea:
 Single dose of ceftriaxone (25 to 50
mg/kg) OR single dose of
Cefotaxime (100 mg/kg, IV or IM)
 Staphylococcus conjunctivitis:
 Frequent washing and irrigation with N/saline
 Erythromycin eye drops
 Pseudomonas aeruginosa:
 Ceftriaxone/Cefotaxime + Gentamicin 10–14 days.
 Or Gentamicin ophthalmic ointment 4 times per day for 2
weeks.
 Herpes simplex:
 Acyclovir 3% ointment
THANK YOU