Neonatal sepsis Flashcards
(14 cards)
What is neonatal sepsis?
Caused by infection within the first 28 days of life.
Early onset sepsis occurs within the first 48-72 hours; late onset occurs after the first 48-72 hours.
What are the common causative organisms of neonatal sepsis?
- group B streptococcus - transmitted from mothers vagina
- E.coli
- Listeria - often ++ with contaminated food (unpasteurised dairy)
- Klebsiella - often ++ with hospital environments (eg. neonatal ICU)
- S.aureus - often ++ with hospital environments (eg. neonatal ICU)
How can GBS be transferred to the baby?
GBS is a common bacteria found in the vagina that doesn’t cause problems to the mother but can be transferred to the baby during labour. Prophylactic antibiotics are used to reduce the risk of transfer if the mother is found to have GBS during pregnancy.
What are the risk factors for neonatal sepsis?
- Vaginal GBS colonisation
- Previous GBS sepsis in baby
- Maternal sepsis, chorioamnionitis or fever over 38 degrees
- Prematurity
- Premature rupture of membranes
- Prolonged rupture of membranes
What are the features of neonatal sepsis?
- Fever
- Reduced tone
- Poor feeding & vomiting
- Resp distress or apnoea / hypoxia
- Tachy or bradycardia
- Jaundice within 24 hours
- Seizures & hypoglycaemia
What are the red flags for neonatal sepsis?
- Confirmed or suspected sepsis in Mum
- Signs of shock
- Seizures
- Term baby needing ventilation
- Respiratory distress starting more than 4 hours after birth
What are the differential diagnoses for neonatal sepsis?
Congenital infection (e.g., TORCH), RDS, TTN, congenital pneumonia, congenital heart disease, metabolic disease, NEC.
What investigations are done for suspected neonatal sepsis?
LP, CRP, FBC.
What is the management for presumed sepsis?
- if there’s one risk factor or clinical feature, monitor the obs and clinical condition for at least 12 hours
- if there are 2 or more risk factors or clinical feature of sepsis, start antibiotics
- antibiotics should be started if there is a single red flag
- abx should be given within 1 hour of making the decision to start them
- blood cultures taken before abx given
- check baseline FBC and CRP
- perform a LP if infection is strongly suspected or if there’s features of meningitis eg. seizures
What antibiotics are given for neonatal sepsis?
Benzylpenicillin and gentamicin as first line; 3rd generation cephalosporin (e.g., cefotaxime) in lower risk babies.
When should CRP and blood culture results be checked again?
Check CRP again at 24 hours and blood culture results at 36 hours.
What do you do after administering antibiotics?
If CRP is less than 10, blood cultures are negative, and baby is clinically well, consider stopping antibiotics.
- If still on treatment, check CRP again at 5 days.
- If at 5 days, CRP is normal, blood cultures are negative, baby is clinically well & lumbar puncture is negative you can stop antibiotics
When can you consider a lumbar puncture (LP)?
If any of the CRP results are greater than 10.
What are the complications of neonatal sepsis?
Poor cognitive development, tCP, visual or hearing deficits.
