neonatal sepsis

1. DR. V. VEERA RATNAKAR REDDY
Senior resident.
05/08/14 Fr. Muller Medical College, Kankanady. 1

2. What is meant by sepsis ??
 Systemic bacterial infections are known by the
generic term neonatal sepsis.
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3. Definition
Neonatal sepsis is a clinical syndrome
characterized by signs and symptoms of
infection with or without accompanying
bacteremia in the first month of life.
Incorporates septicemia, pneumonia, and meningitis
of the newborn.
Incidence approximately 30/1000 live births
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4. Etiology
E.Coli, Staph aureus, Group B Streptococcus and
Klebsiella sp. Are responsible for most cases.
 MC CAUSE OF CONG PNEUMONIA-?
As per aiims study both extramural and intramural
cause of sepsis is in the order of: Klebsiella>
s.aureus>e. coli.
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5. EARLY ONSET LATE ONSET
ONSET <72 hrs >72 hrs
SOURCE Maternal Nursery
Organism Gp B Strept, E.
Coli
Gram –ve, Staph
Aureus
Maternal Risk
Factors
Present Absent
Presentation Multisystem,
Pneumonia
Focal, Meningitis
Course Fatal Recovery
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Types: EOS, LOS, VLOS

6. PREDISPOSING RISK FACTORS
MAJOR
PROM> 24 hrs
Maternal Fever >38°C
(Within 15 days)
Foul Smell Liquor
(Chorioamnionitis)
Fetal distress (pr.lab)
MINOR
LBW
Prematurity
Birth Asphyxia
Maternal WBC>
15,000
Vaginal Swab +ve for
GBS
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7. Infant born through foul smelling liquor/
3 of risk factors/
1 major+2 minor
require treatment with Abs
 with 2 risk factors= needs to be investigated
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8. Complaints: non specific
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10. ???????//??/////???////??//
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12. Skin Infection

13. ?????
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14. SSS

15. Swelling left knee

16. Umblical
Sepsis

17. Seizures

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20. Septic Shock On Ventilator

21. CLINICAL PRESENTATION
NON SPECIFIC- Lethargy, poor feeding, hypothermia/ fever,
pale/ cyanosis
MENINGITIS- Convulsions
PNEUMONIA- Apnoea/ Resp. Distress
NEC- Vomiting, Abd. Distension
DIC- Bleeding
PYELONEPHRITIS
SHOCK
Pathological JAUNDICE
SCLEREMA
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22. DIAGNOSIS: SEPTIC SCREEN GOLDSTD INV: ??? & repeat t to be done?
SEPTIC SCREEN: TC+ANC+INC/NC, +Mesr+CRP
TC >20,000; <5,000
DC- Absolute Neutropenia, Band forms/Total >
20%
PS- Toxic Granulations
CRP >6mcg/ml.
Micro ESR > 15mm
LP: in eos- culture +ve, los-all & repeat lp
GASTRIC ASPIRATE for polymorphs > 5/HPF
Urine c/s: EOS: not indi, LOS: all
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24. TREATMENT
ANTIBIOTICS- Ampi+Genta; Cefotaxim+Amikacin
SUPPORTIVE
Fluid & electrolytes
Shock/ Hypoxia/ Acidosis
Nutrition
Blood (DIC)
Treatment of Hyperbilirubinemia
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25. Duration of AB COURSE:
Meningitis (with or without positive blood/CSF
culture) : 21
Blood culture positive but no meningitis:14
Culture negative, sepsis screen positive and
clinicalcourse consistent with sepsis: 7-10
Culture and sepsis screen negative, but clinical
coursecompatible with sepsis: 5-7
Arthritis, endocarditis, osteomyelitis: 4 -6w
Ventriculitis: 6wk
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26. NEWER MODALITIES
Double volume exchange transfusion
Cytokines (GM-CSF, G-CSF, γ Interferon)
Immunoglobulins
Fibronectin- large molecular weight glycoprotein
 ↑ neutrophil & macrophage response to infection
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27. Summary
Systemic infections in newborn is known as neonatal
sepsis.
Clinical symptomatology is vague and non-specific
Mortality is high among LBW babies and gram
negative sepsis.
Combination of Cefotaxim and Amikacin found to be
a better combination.
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28. This to this
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29. Thank you
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