*Neonatal infection + sepsis

Question 1

What is neonatal infection?

Answer 1

Disease of an infant <1 month that is clinically ill with positive blood cultures

Question 2

Why are neonates more susceptible to infection?

Answer 2

• Thin, easily damaged skin
• Umbilical cord
• Lack of normal bacteria on skin and in GIT
• Impaired phagocytosis
• Inadequate immunoglobulins
• Immunity not mature until 2-5 years

Question 3

TORCH?

Answer 3

Toxyplasmosis
Other: syphilis, varicella-zoster, parvovirus
Rubella
Cytomegalovirus
Herpes
Syphillis

Some of the most common infections associated with congenital anomalies

Question 4

Signs of GBS (early-onset)?

Answer 4

• Respiratory distress
• Pallor
• Tachycardia, tachypnoea
• Fever, hypothermia
• Decreased activity

Complications: pneumonia, septicaemia, meningitis

Question 5

Risk factors for neonatal infection

Answer 5

.Low socioeconomic

Antenatal
* Congenital infections - TORCH

Intrapartum
* Prolonged ROM
* Preterm birth
* Prolonged labour
* Maternal infection/pyrexia
* Excessive VEs
* Offensive smelling liquor
* Instrumental birth

Postnatal
* Resuscitation
* Instrumental birth
* Respiratory support
* Invasive procedures
* Prematurity
* Skin - staph aureus, umbilicus

Question 6

Signs and symptoms of neonatal infection

Answer 6

Hypotonia, lethargy
Pyrexia, hypothermia
Poor skin perfusion
Poor feeding
Unexplained jaundice
Unstable PGL
Apnoea and seizures
Resp distress
GI - vomiting, diarrhoea, abdo distension
Skin - septic lesions
Discharge from eyes / umbilicus
Thrombocytopenia

Question 7

Midwives role in preventing neonatal infection

Answer 7

• Universal precautions
• Preconception and pregnancy screening
• Vaccinating - Hep B and Rubella
• Treatment of STIs
• GBS screening
• Education on teratogenic risks of consuming listeria
• Minimising VEs and invasive procedures
• Education around ROM
• BF promotion and support
• Encouraging rooming in
• Own equipment for each baby
• Minimal handling
• Discharge education

Question 8

Management of suspected neonatal infection
Early onset sepsis <72hrs

Answer 8

Blood cultures
Gastric asiprate - if has not fed
Ear swab
Tracheal aspirate (if intubated)
FBC, U&Es, PGL for baseline
Consider lumbar puncture
CRP
Chest xrap
Vital signs
Minimal handling and cluster care
ABs - parenteral therapy with penicillin and gentamicin

Question 9

Management of suspected late onset sepsis (>72hrs)

Answer 9

Blood cultures
Culture of specific sites as indicated (trachea, skin, umbilicus
FBC, U&Es, PGL for baseline
Lumbar puncture
CRP
Chest xray
Suprapubic urine
Selective AB choice