Neonatal sepsis - NNU teaching

Question 1

When does sepsis happen in babies?

Answer 1

• Prenatal
• Perinatal
• Post natal - early (48-72hrs) and late is after

Question 2

What is congenital infection?

Answer 2

Picked up in utero - eg TORCH either haematogenous or transplacental

Question 3

Neonatal infection and most common causes early onset

Answer 3

• Infection acquired during/after delivery
• eg GBS, e.coli - early onset

Question 4

Most common causes late onset post natal sepsis

Answer 4

• CLABSI - central line associated blood stream infections
• NEC
• Gram -ve klebsiella (lack gut colonsation, not normalised for a while and abx use causes lack gut bacteria)
• Gram +ve eg staphylococcus aureus (lines), enterococcus
• Coagulase negative staphylococcus - 60% cause (eg epidermidis)
• Meningitis - secondary to blood stream infection
• Fungal - abx given and can wipe out competition
• Viral

Question 5

What is GBS?

Answer 5

• Normal bowel and vaginal flora
• We don’t screen as may carry it during labour even if negative test early on
• Only 1 in 100 colonised get invasive disease due to GBS

Question 6

Antibiotics for neonatal sepsis - starting point

Answer 6

• IV benzylpenicillin and gentamicin
• Benz for GBS and gent for E-coli
• Should be given within 1hr of decision of needing it

Question 7

Risk factors of neonatal sepsis - early onset

Answer 7

• Maternal infection during labour
• Prematurity
• Low birth weight
• Prolonged rupture of membranes - more than 18hrs before labour begins
• Maternal GBS

Question 8

RF of late onset neonatal sepsis

Answer 8

• Premature
• LBW
• Invasive procedures - eg IV catheters, intubation
• Prolonged hospitalisation
• Associated conditions

Question 9

When to definitely put baby on abx?

Answer 9

• If another baby in multiple pregnancy has suspected or confirmed infection

Question 10

What are other RF suggesting should put on abx during labour?

Answer 10

• Invasive GBS in previous pregnancy or colonisation
• Pre-term birth - before 37 weeks
• Confirmed rupture of membranes for more than 18hrs before preterm
• Maternal pyrexia of 38

Question 11

Red flags for neonates when to put on abx

Answer 11

• Apnoea
• Seizures
• Need for CPR
• Need for mechanical ventilation
• Signs of shock

Question 12

What to ask re labour?

Answer 12

• Duration of rupture of membranes - when did waters break?
• Pyrexia during labour?
• Did they give maternal GBS prophylaxis in labour?

Question 13

History - post natal

Answer 13

• Gestational age
• Why did they deliver early if so?
• Birth weight
• APGAR scores - any distress?
• Feeding
• Passed meconium and urine
• NEWTT2 score

Question 14

Inv for ?neonatal sepsis

Answer 14

Bloods:
* FBC - raised WCC and low plt
* Blood culture - supposed to be back <36hrs but not often
* CRP
* Capillary blood gas

Potential lumbar puncture

Question 15

Gentamicin monitoring and why

Answer 15

• Check level - pre second dose
• Give second dose
• Then get results before third dose and know whether need to alter dose
• As it is nephrotoxic and ototoxic

Question 16

How to decide when to lumbar puncture?

Answer 16

• Raised CRP (varies level but around 30 is normal)
• Clinically very unwell baby

Question 17

Later onset sepsis abx

Answer 17

Flucloxicillin and gentamicin

Question 18

Differentials for neonatal sepsis presentation

Answer 18

• Congenital infections - TORCH
• Respiratory distress syndrome
• Transient tachypnoea of newborn - looks well
• Congenital pneumonia
• Congenital heart disease - if duct dependent (often close within 6-12hrs)
• Metabolic disease
• NEC

Question 19

Risks of sepsis in neonates

Answer 19

• Death
• Poor cognitive development
• Visual/hearing deficits - if meningitis, detailed hearing screening done after meningitis
• Cerebral palsy - periventricualr leukomalacia