Paeds Emergencies

Question 1

What is neonatal sepsis?

Answer 1

EARLY onset: <72h since birth
LATE onset: >72h since birth (sometimes >7 days)

Question 2

Which organisms most commonly cause EARLY onset neonatal sepsis?

Answer 2

Acquired via contaminated amniotic fluid or during vaginal delivery:
Group B Streptococcus (75%)
Escherichia Coli
Listeria monocytogenes (less common)

Question 3

Which organisms most commonly cause LATE onset neonatal sepsis?

Answer 3

Acquired from environment post-delivery, normally from parents or HCPs

Group B Streptococcus
Escherichia Coli

Staphylococcus epidermidis
Pseudomonas aeruginosa, Klebsiella, Enterobacter

Question 4

Which are the 2 most common organisms in both early onset and late onset sepsis?

Answer 4

Group B Streptococcus
Escherichia Coli

Question 5

List 5 risk factors for neonatal sepsis

Answer 5

Previous baby with GBS infection
GBS colonisation from prenatal screening
Intrapartum temp. ≥38ºC,
PROM ≥18h
Evidence of maternal chorioamnionitis

Question 6

Which babies are most commonly affected by neonatal sepsis?

Answer 6

Premature (<37w): ~85% of neonatal sepsis cases

Low birth weight (<2.5kg): ~80% are low birth weight

Question 7

Give 9 signs of neonatal sepsis

Answer 7

Respiratory distress (85%)

Tachycardia: common, but non-specific

Apnoea (40%)

Apparent change in mental status/ lethargy

Jaundice (35%)

Seizures (35%): if cause of sepsis is meningitis

Poor/ reduced feeding (30%)

Abdominal distention (20%)

Vomiting (25%)

Question 8

What are 4 signs of respiratory distress in an infant with neonatal sepsis?

Answer 8

Grunting
Nasal flaring
Use of accessory respiratory muscles
Tachypnoea

Question 9

Why should temperature alone not be used for indication of neonatal sepsis?

Answer 9

Term: more likely to be febrile
Pre-term: more likely to be hypothermic

Question 10

What investigations should be performed in neonatal sepsis?

Answer 10

2x Blood cultures: establish dx

FBC: abnormal neutrophil counts (neutrophilia + neutropenia)

CRP: not useful for dx, but sequential assessment will help to guide Mx + progress with Tx. Usually raised

Blood gases: metabolic acidosis is particularly concerning for neonatal sepsis, esp. a base deficit of ≥10 mmol/L

Urine MC+S: rarely +ve in EOS, more useful in LOS. Signs of infection (e.g. raised leukocytes, +ve culture, haematuria, proteinuria) if UTI is the source

Lumbar puncture: if concern of meningitis as source based on clinical features/ as part of septic screen in any baby <28d

Question 11

What is the management of neonatal sepsis?

Answer 11

IV Benzylpenicillin/ Ampicillin + Gentamicin
Repeat CRP at 18-24h

Question 12

How may neonatal sepsis be prevented?

Answer 12

Benzylpenicillin intrapartum abx prophylaxis for:
Previous pregnancy with GBS
Previous baby with early- or late-onset GBS disease
Preterm labour regardless of GBS status
Pyrexia during labour (>38ºC)
Clinical dx of chorioamnionitis
GBS colonisation, bacteriuria or infection during current pregnancy

Question 13

What is the risk of maternal GBS carriage in a current pregnancy if there has been previous GBS carriage?

Answer 13

50%