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بسم الله الرحمن الرحيم Neonatal Sepsis BKTH  Department of Pediatrics Dr. magdah & Dr. Amal Unite April 2010 By: Dr.  Mohamed Eisam Elhag Mahmoud MBBS,  Alneelain University Faculty of Medicine Note:  Dr. Mohammed Isam Al-Hajj  does not have any financial relationships to disclose nor will he discuss any non-approved drug  or device uses.
Babies and Bacteria... What will I learn ? Pathology * Causes * Symptoms * Diagnosis * Treatments
Definition ,[object Object]
Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology ,[object Object],[object Object],[object Object],[object Object]
Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Early onset sepsis Late onset sepsis Pathogens Group B Streptococcus E. coli Haemophilus influenzae Listeria Virus, STD Coagulase negative staphylococcus Staphy. aureus E. coli Klebsiella Pseudomonas Enterobacter Baby in risk Term, near-term baby Preterm baby
Predisposing Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Predisposing Factors ,[object Object],[object Object],[object Object],[object Object],[object Object]
pathogens can enter a neonate’s body in many ways ! Prenatal Maternal Substance Abuse Premature Rupture of Membranes (>18 Hours) Maternal Infection Perinatal Microbial Colonization at Birth Maternal Infection Vaginal Exam of Mother Postnatal Invasive Catheters Endotracheal Intubation Exposure to Nosocomial Microorganisms
Predisposing Factors ,[object Object],[object Object],[object Object],[object Object]
Preterm Labor/PROM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
S EPSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
S EPSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Routes of Infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transplacental/Hematogenous ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ascending/Birth Canal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nosocomial ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Coagulase-Negative Staphylococci ,[object Object],[object Object],[object Object],[object Object]
Infection ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Presentation ,[object Object],[object Object]
Non-specific/Common ,[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object]
Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Results “Trigger Points”  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Lumbar puncture (CSF) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
False negative Blood Culture ,[object Object],[object Object],[object Object]
D ifferential  D iagnosis  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment First five days.   After first five days.   Start  ampicillin   and  gentamicin   for  1.all VLBW neonates  and 2. any infant who --Appears septic or is sicker than would be usually anticipated.   --Has any vascular catheter  Start  amoxycillin  and  cefoxitin  in all other babies   Start  vancomycin  and  amikacin  in all babies  (Almost all Coag negative Staph is sensitive to Amikacin but resistant to gentamicin. ) ( Flucloxacillin  being used at present because of an increased number of Staph aureus isolates within the unit ) Add  amoxycillin  if specific cover for Enterococci, Strep fecaelis [suspected NEC], Listeria or Group B Strep is needed.
Treatment ,[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object]
Neonatal Sepsis: the special case of Group B Strep Sepsis
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],GBS S EPSIS
Mothers in labor or with ROM  should be treated  if: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],GBS S EPSIS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],GBS S EPSIS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],GBS S EPSIS
GBS prophylaxis  ,[object Object],[object Object],[object Object]
 
Diagnosis
S EPSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Signs  according to WHO Integrated Management of Childhood illness ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],S EPSIS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
New Diagnostic Methods  ,[object Object],[object Object],[object Object],[object Object],[object Object]
S EPSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prognosis ,[object Object],[object Object],[object Object]
Infection and ND Outcome ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Infection  Sepsis  Alone  Sepsis+NEC Sepsis+Meningitis
Late Onset Infection ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention of Nosocomial Infections ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Congenital Rubella Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chicken Pox ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When to suspect Cong. Infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How investigate Cong. Infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How to treat ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object]
Thank You!!

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Neonatal sepsis ppp

  • 1. بسم الله الرحمن الرحيم Neonatal Sepsis BKTH Department of Pediatrics Dr. magdah & Dr. Amal Unite April 2010 By: Dr. Mohamed Eisam Elhag Mahmoud MBBS, Alneelain University Faculty of Medicine Note: Dr. Mohammed Isam Al-Hajj does not have any financial relationships to disclose nor will he discuss any non-approved drug or device uses.
  • 2. Babies and Bacteria... What will I learn ? Pathology * Causes * Symptoms * Diagnosis * Treatments
  • 3.
  • 4.
  • 5.
  • 6.
  • 7. Early onset sepsis Late onset sepsis Pathogens Group B Streptococcus E. coli Haemophilus influenzae Listeria Virus, STD Coagulase negative staphylococcus Staphy. aureus E. coli Klebsiella Pseudomonas Enterobacter Baby in risk Term, near-term baby Preterm baby
  • 8.
  • 9.
  • 10. pathogens can enter a neonate’s body in many ways ! Prenatal Maternal Substance Abuse Premature Rupture of Membranes (>18 Hours) Maternal Infection Perinatal Microbial Colonization at Birth Maternal Infection Vaginal Exam of Mother Postnatal Invasive Catheters Endotracheal Intubation Exposure to Nosocomial Microorganisms
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.  
  • 29.
  • 30.
  • 31.
  • 32.
  • 33. Treatment First five days. After first five days. Start ampicillin and gentamicin for 1.all VLBW neonates and 2. any infant who --Appears septic or is sicker than would be usually anticipated. --Has any vascular catheter Start amoxycillin and cefoxitin in all other babies Start vancomycin and amikacin in all babies (Almost all Coag negative Staph is sensitive to Amikacin but resistant to gentamicin. ) ( Flucloxacillin being used at present because of an increased number of Staph aureus isolates within the unit ) Add amoxycillin if specific cover for Enterococci, Strep fecaelis [suspected NEC], Listeria or Group B Strep is needed.
  • 34.
  • 35.
  • 36. Neonatal Sepsis: the special case of Group B Strep Sepsis
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.  
  • 45.
  • 46.
  • 47.
  • 48.
  • 49.
  • 50.
  • 51.
  • 52.
  • 53. Clinical Infection Sepsis Alone Sepsis+NEC Sepsis+Meningitis
  • 54.
  • 55.
  • 56.
  • 57.
  • 58.
  • 59.
  • 60.
  • 61.  
  • 62.