complex neonates

Question 1

Definition: early onset sepsis

Answer 1

Sepsis occurring <72 hours of birth, vertical transmission through the birth canal, symptoms within 24 hours of birth, mainly caused by GBS and E. Coli

Early onset sepsis results from vertical transmission through the birth canal, with symptoms appearing within 24 hours of birth.

Question 2

Definition of late-onset sepsis in neonates?

Answer 2

Sepsis occurring >72 hours of age, with environmental transmission, possible late presentation of vertical transmission

This may also include possible late presentation of vertical transmission.

Question 3

Symptoms of neonatal infection.

Answer 3

Apnoea
Seizure
Need for cardiopulmonary resuscitation
Need for mechanical ventilation
Signs of shock
Altered behaviour/responsiveness
Altered muscle tone
Feeding difficulties
Feed intolerance
Brady/tachycardia
Respiratory distress
Hypoxia
Jaundice <24 hours
Temperature abnormality
Metabolic acidosis

Question 4

What is a red flag risk factor for neonatal infection?

Answer 4

Infection in the other twin/triplet

This indicates a higher risk for the neonate.

Question 5

Name other risk factors associated with neonatal infection.

Answer 5

GBS in a previous baby
Maternal GBS infection in the current pregnancy
Preterm birth with spontaneous labour
PROM (>18 hours for preterm, >24 hours for term)
Intrapartum pyrexia >38
Diagnosis of chorioamnionitis
SROM
LWB
FSE
Fetal blood sampling
CS
Overzealous bathing

Question 6

Intrapartum managment plan

Answer 6

Offer antibiotics in labour to women who are: in preterm labour, have GBS in current pregnancy, have GBS in previous pregnancy and have no negative test 3 to 5 weeks before birht in current pregnancy, have had a previous baby with GBS, have chorioamnionitis. Offer immediate IOL or CS to women who are between 34 ad 37 weeks and have PPROM and GBS in current pregnancy

This is also applicable for women with GBS in previous pregnancies without a negative test 3 to 5 weeks before birth.

Question 7

Postnatal managment plan

Answer 7

Immediate clinical assessment, refer to paediatrics, start antibiotics for babies qith any red risk factor or with 2 other risk factors or any clinical indicators: immediate clinical assessment with observations, refer to paediatrics, start ABX. In babies without Red risk factor or only 1 risk factor refer to paed and use clinical judgement if safe to withold ABX, whether vital signs and clinical condition need to be monitored for 12 hours.

This ensures prompt management of potential infections.

Question 8

What is the importance of following trust guidelines in monitoring newborns?

Answer 8

Ensures appropriate frequency and length of observations

Adhering to guidelines helps maintain consistent care standards.