Neonatal infections Flashcards
(39 cards)
Define congenital infection
Babies are born with congenital infections i.e. transmitted vertically from mother to baby
Congenital infections can occur anytime during pregnancy and birth
What congenital infections are mothers screened for at the moment?
–Hep B
–HIV
–Rubella
–Syphilis
What is the TORCH screen?
–Toxoplasmosis
–Other – syphilis; HIV; hepatitis B/C
–Rubella
–Cytomegalovirus (CMV)
–Herpes simplex virus (HSV)
What are some common clinical features of congenital infections?
•Common clinical features
–Mild/no apparent maternal infection
–Wide range of severity in the baby
–Similar clinical presentation
–Serological diagnosis
–Long term sequelae if untreated
•Examples
–Low platelets, rash
–Cerebral abnormalities
–Hepatosplenomegaly/hepatitis/jaundice
Describe congenital toxoplasmosis
- Symptoms at birth
- Long term side effects
- May be asymptomatic at birth
40% symptomatic at birth:
- Choroidoretinitis
- Microcephaly/hydrocephalus
- Intracranial calcifications
- Seizures
- Hepatosplenomegaly/jaundice
- Long term side effects:
- Deafness
- Low IQ
- Microcephaly
Describe the effects of congenital rubella syndrome on the following organs:
- Fetus
- Eyes
- CV system
- Ears
- Brain
- Other
- Effect on foetus – dependent on time of infection
- Mechanism – mitotic arrest of cells; angiopathy; growth inhibitor effect
- Eyes: cataracts; microphthalmia; glaucoma; reintopathy
- Cardiovascular syndrome; PDA; ASD/VSD
- Ears; deafness
- Brain: microcephaly; meningoencephalitis; developmental delay
- Other: growth retardation; bone disease; hepatosplenomegaly; thrombocytopenia; rash
What does this baby have?
Herpes simplex virus (HSV)
Name some congenital infections
- Hepatitis B and C
- HIV
- Listeria monocytogenes
- Group B Streptococcus
- Syphilis
- Chlamydia trachomatis
–Infection transmitted during delivery
–Mother may be asymptomatic
–Causes neonatal conjunctivitis, or rarely pneumonia
–Treated with erythromycin
•Mycoplasma species
–Mycoplasma hominis and Ureaplasma urealyticum
•Parvovirus
Define the neonatal period
- Definition when born at FGA is the first 4-6 weeks of life
- If born early (premature) neonatal period longer and is adjusted for expected birth date
Describe neonatal infections
- Higher incidence of infections
- Can become ill rapidly and seriously
- Unlike adults or older children – need to treat with antibiotics when first suspicion of infection
- Why are neonates at higher risk of infections?
- Why are premature infants at higher risk of infections?
- Immature host defences
- Increased risk with increased prematurity
- Less maternal IgG
- NICU care
- Exposure to microorganisms; colonisation and infection
What are some common neonatal infections?
- Early and late onset infection
- Early onset – usually within 48 hours of birth
–Some definitions 3-5 days
•Organisms
- Group B streptococci
- E. coli
- Listeria monocytogenes
- Describe group B streptococci
- What does it cause in neonates?
1.
- Gram positive coccus
- Catalase negative
- Beta-haemolytic
- Lancefield Group B
- In neonates:
- Bacteraemia
- Meningitis
- Disseminated infection e.g. joint infections
- Describe E.coli
- What does it cause in neonates?
- Gram negative rod
- In neonates:
- Bacteraemia
- Meningitis
- UTI
What are some early onset sepsis risk factors for
- Maternal?
- Baby?
1.Maternal
- PROM/prem. Labour
- Fever
- Foetal distress
- Meconium staining
- Previous history
- Baby
- Birth asphyxia
- Resp. distress
- Low BP
- Acidosis
- Hypoglycaemia
- Neutropenia
- Rash
- Hepatosplenomegaly
- Jaundice
What investigations can be done to check for early onset sepsis?
- Full blood count
- C-reactive protein (CRP)
- Blood culture
- Deep ear swab
- Lumbar puncture (CSF)
- Surface swabs
- Chest X-ray (full body)
What is the management for early onset neonatal sepsis?
Supportive management:
- Ventilation
- Circulation
- Nutrition
- Antibiotics: e.g. benzylpenicillin & gentamicin
Neonatal infection (early onset): antibiotics for prevention and treatment
- Define late onset sepsis
- What organisms cause late onset sepsis?
- Late onset sepsis - after 48-72 hours
- Organisms that can cause late onset sepsis:
- Coagulase negative Staphylococci (CoNS)
- Group B streptococci
- E. coli
- Listeria monocytogenes
- S. aureus
- Enterococcus sp.
- Gram negatives – Klebsiella spp. /Enterobacter spp. /Pseudomonas aeruginosa/Citrobacter koseri
- Candida species
What are the clinical features of late onset sepsis?
- Bradycardia
- Apnoea
- Poor feeding/bilious aspirates/ abdominal distension
- Irritability
- Convulsions
- Jaundice
- Respiratory distress
- Increased CRP; sudden changes in WCC/platelets
- Focal inflammation – e.g. Umbilicus; drip sites etc.
What investigations should be done for late onset sepsis?
- FBC
- CRP
- Blood culture(s)
- Urine
- ET secretions if ventilated
- Swabs from any infected sites
What is the treatment for late onset sepsis in neonates?
- Treat early – lower threshold for starting therapy
- Review and stop antibiotics if cultures negative and clinically stable
- NICU-Example of antibiotics for late onset sepsis:
- 1st line: cefotaxime & vancomycin
- 2nd line: meropenem
- Community acquired late onset neonatal infections: cefotaxime, amoxicillin +/-gentamicin
Name some common viral infections in childhood
- Chickenpox (VZV)
- Herpes simplex – cold sores/stomatitis;
- HHV6
- HHV8
- EBV
- CMV
- RSV
- enteroviruses etc
Bacterial infections are important and may cause secondary infection after viral illness e.g. iGAS (invasive group A streptoccocus) post VSV infection
What investigations should be done for a child with a suspected infection?
- FBC
- CRP
- Blood cultures
- Urine
- +/- Sputum; throat swabs etc
What is the most important bacterial cause of paediatric morbidity and mortality?
Meningitis
