Early neonatal sepsis

Question 1

When are neonates at risk of neonatal sepsis?

Answer 1

In utero around the time of delivery and postnatally

Question 2

What is early onset neonatal sepsis

Answer 2

Sepsis occurring within the first 48-72hours of life

Question 3

Which bacteria commonly cause early onset neonatal sepsis?

Answer 3

Group B streptococcus 
E.coli
Listeria monocytogenes
H. influenzae
Coagulase negative staphylococcus

Question 4

Describe the pathophysiology of early neonatal sepsis

Answer 4

Ascending infection in the mother with chorioamnionitis perinatally via direct contact in the birth canal and haematogenous spread

Question 5

What does early neonatal sepsis present with?

Answer 5

Respiratory distress
Pneumonia
Septicaemia

Question 6

What does late onset neonatal sepsis present with?

Answer 6

Septicaemia

Meningitis

Question 7

Which babies warrant investigation for early onset neonatal sepsis?

Answer 7

One red flag risk factor or clinical indicator

Babies with 2 non-red flag risk factors/clinical indicators

Question 8

List some risk factors for infection

Answer 8

Invasive group B streptococcal infection in a previous baby

Maternal group B streptococcal colonisation, bacteriuruia or infection in the current pregannacy

Prelabour rupture of membranes

Preterm birth following spontaenous labour (<37weeks)

Syspected or confirmed rupture of membranes >18hrs in preterm birth

Intrapartum fever >38 or confirmed/suspected chorioamnionitis

Parenteral antibiotic given to the woman for confirmed or suspected invasive bacterial infection at any time during labour or in the 24hours before and after birth

Suspected or confirmed infection in another baby in case of multiple pregancy

Question 9

List the clinical features suggestive of infection

Answer 9

Altered behaviour or responsiveness
Altered muscle tone
Feeding difficulties
Feed intolerance - vomiting, excessive gastric aspirates and abdominal distension

Abnormal heart rate

Signs of respiratory distress
Respiratory distress starting >4hrs after birth

Hypoxia

Jaundice within 24hrs of birth

Seizures

Need for CPR

Need for mechanical ventilation

Temp abnormalities <36 or >38

Signs of shock

Unexplained excessive bleeding, thrombocytopenia or abnormal coagulation

Oliguria persisting beyond 24hrs

Altered glucose homeostasis

Metabolic acidosis

Local signs of infection

Question 10

List some investigations for early onset neonatal sepsis

Answer 10

FBC, CRP, blood cultures, relevant swabs, urinalysis

CRP repeated at 18-24hours

Lumbar puncture if thought safe to do so and strong clinical suspicion of infection or clinical symptoms or signs suggesting meningitis or if the first or repeated CRP is high

Question 11

Describe the management of early onset neonatal sepsis

Answer 11

IV benzylpenicillin and gentamicin as 1st choice empirical antibioitcs

Question 12

Why should antibiotics be considered stopping at 36 hours?

Answer 12

If negative blood culture

If initial clinical suspicion of infection was not strong

If babys condition is reasuring with no indicators of infection

If CRP trends are reassuring

Question 13

What is the overall mortality rate for late preterm and term infants from early onset neonatal sepsis?

Answer 13

2-4%

Question 14

Which bacteria confers a higher mortality rate?

Answer 14

E.coli

Question 15

How long should antibiotics be continued for if blood cultures are positive?

Answer 15

7-10 days (up to 14days if CSF positive)

Question 16

How long will babies with a raised CRP and negative blood cultures continue to have IV antibiotics for?

Answer 16

5 days