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1

The presence of bacteria in the bloodstream
-This can be a transient, self-limited phenomenon, cleared by immune system without event but can also progress to sepsis

bacteremia
*can seed other sites such as bone, lung, and meninges

2

Bacteremia coupled with inadequate perfusion and end-organ involvement
Meaning, decreased blood flow
Causing damage to important organs

sepsis

3

Sepsis which occurs in a neonate within the first 3 days of life

early-onset sepsis (EOS)
*Vertical transmission

4

Sepsis which occurs after the first 3 days until 2 to 3 months of life (definitions vary)

Late-onset (LOS)
*Horizontal transmission

5

sx:
-Temperature may be elevated or depressed. Recall that normal range is 36.5 to 37.5
-Tachypnea; ie, respiratory rate > 60/min
-Other signs of respiratory distress (retractions)
-Poor color (cyanosis, poor perfuson= mallor)
-Decreased responsiveness/lethargy
-Poor feeding
-Irritability or sleepiness

sepsis

6

Babies have a limited repertoire. Symptoms of ___ may be indistinguishable from non-infectious illness.

sepsis

7

mortality rate of EOS

15%
*Higher mortality in pre-term babies and Lower in full-term

8

what type of sepsis is even more likely to be complicated by meningitis with its attendant morbidity

late onset sepsis

9

Which bacterial organisms are involved with sepsis

1. Group B Strep
2. E. coli- actually #1 in preterm babies
3. Other strep species, most commonly Pneumococcus
4. Enterococcus (Group D strep)
5. Staph (usually iatrogenic)
6. Listeria
7. Klebsiella
*These organisms all come from vagina or its neighbor, the GI tract

10

How does transmission of sepsis occur?

-During labor membranes rupture or become leaky
-Organisms can ascend from the birth canal (vagina)
-Fluid becomes infected, fetus inhales or swallows it and also becomes infected

11

if mom goes into labor early for no known reason think...

possible infection like sepsis (Premature babies are more vulnerable because of less adequate immune system)


*Very high risk for EOS
Also higher risk for mortality associated with sepsis
It may be that the premature labor was prompted by brewing infection

12

MAJOR RISK FACTORS of EOS

*Chorioamnionitis
Maternal Group B Strep carriage
Prolonged rupture of the membranes (18 hrs)
Prematurity

13

MINOR RISK FACTORS of EOS

Ethnicity (black women are at higher risk of GBS colonization)
Low socioeconomic status
Male sex
Low birth weight (>2500 grams)

14

Definition of Chorioamnionitis

Maternal temperature during labor > 38.o C or 1oo.4 F
And at least 2 other features
1. maternal leukocytosis- WBC > 15,000 in blood
2. maternal tachycardia- > 100 beats/min
3. fetal tachycardia- baseline > 160 beats/min
4. uterine tenderness (tenderness=elicited, pain=subjective)
5. foul smelling amniotic fluid

15

Gram positive bacteria
Carrier state in mother (in her normal flora)

GBS
*6-30% prevalence internationally

16

how is GBS transmitted

-Not sexually transmitted
-50% vertical transmission
-Late onset disease is horizontal transmission

17

____% of babies born to mothers with GBS will develop early onset sepsis

1%

18

___% reduction in GBS sepsis from 1990s

87%
*Currently- all moms are cultured for GBS at 36 weeks and treat when they go into labor

19

risk factors for GBS

-Previous child who had early-onset GBS sepsis
-GBS bactiuria during current pregnancy
-Maternal fever/chorio
-Preterm labor
*We revert to these criteria now when GBS culture is not available

20

Definition of prolonged rupture

>18 hrs
*The longer the membranes are ruptured, the higher the likelihood of ascending infection

21

definition of Prematurity

gestational age less than 37 yrs

22

sepsis workup includes

*Blood culture is mandatory (1-2ml from 1 site)
-Chest X-ray (almost always done)
-Lumbar puncture, aka “spinal tap” (look for WBC in CSF)
-Complete blood count (CBC)
-C-reactive protein
-Urine culture is NOT indicated in septic workup of a newborn in the first 3 days of life. It should be included in workup of late onset sepsis

23

blood culture of spesis characteristics

1-2ml
-Almost all pathogens will grow within 48hrs
-Positive blood culture is diagnostic of neonatal sepsis but negative culture does not rule it

24

When to include Spinal Tap for sepsis dx

-positive blood culture (Best performed before starting antibiotics, can be delayed if baby is unstable)
-sx referable to CNS (Neonates with symptoms of meningitis -TRUE lethargy, abnormal tone, excessive irritability, bulging fontanel, or septic shock)
-being proactive before starting antibiotics

25

sx of meningitis

lethargy, abnormal tone, excessive irritability, bulging fontanel, or septic shock

26

important features of CBC to consider

1. Total WBC count (but can be caused by stress too ie. labor)
2. Differential
3. Absolute neutrophil count
4. Immature/total ratio (I/T)
5. Immature leukocyte count
6. Normal ranges are broad and depend upon timing **best time is at least 6 hours after birth

*can be a clue but not diagnostic

27

hematopoiesis

maturation and differentiation of WBC

28

the cell line most responsible for managing bacterial infections.

neutrophils
*Mature cells of the granulocyte line
**Also known as polymorphonucleocytes or “polys”

29

Immature forms of neutrophils include:

Bands
Metamyelocytes
Myelocytes
Promyelocytes and myeloblasts are not in circulation so not on CBC

30

Hematopoiesis of neutrophils

myeloid stem cell--> myeloblast --> N. promyelocyte --> N. myelocyte--> N. Metamyelocytes ---> N. Band---> Neutrophil