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Neonatal Pathophysiology > Sepsis > Flashcards

Flashcards in Sepsis Deck (24):
1

What antibiotic is not very effective against G neg bacteria in the CNS?

gent

2

What antibiotic is generally effective against staph pneumonia and community acquired infections?

vanc

3

What are the incidences of HSV 1 & 2?

HSV1 (20-25%)
HSV2 975-85%)
HSV incidence ranges from 1 in 3-20k

4

What is the risk of infx during primary HSV genital infx near delivery?

25-60%

5

What is the risk of infx during reactivation HSV genital infx near delivery?

< 2%

6

What percentage of babes with neonatal HSV are born to mothers with no h/o HSV?

75%

7

What increases the risk of neonatal HSV transmission?

1) prematurity
2) PROM ( > 4h)
3) skin laceration
4) scalp electrode

8

What percentage of neonatal HSV is transmitted through intrauterine infx?

5%
transplacental or ascending

9

What percentage of neonatal HSV is transmitted through postnatal infx?

10%

10

What is the incidence of viremia (disseminated dz) in neonatal HSV?

25%

11

What is the incidence of neuronal spread with CNS dz in neonatal HSV?

30%

12

What is the clinical presentation of disseminated neonatal HSV?

1) DIC
2) Pneumonia
3) Hepatitis
4) CNS involvement (60-75%)
5) skin lesions (66%)
6) mortality (25%)- up to 85% without ACV

13

What is the clinical presentation of CNS neonatal HSV?

1) seizures (41%)
2) lethargy
3) irritability
4) poor feeding
5) temperature instability
6) skin lesions (66%)
7) neurologic morbidity (~70%)

14

What is the incidence of skin, eyes, mouth dz in neonatal HSV?

45%

15

What is the indicated management of a symptomatic newborn exposed to HSV at delivery?

1) culture or PCR of mucosal surfaces and blood
2) lesions for HSV PCR/culture (unroofed vesicles)
3) CSF for HSV PCR and indices
4) CBC with diff and LFT's (ALT) and BUN/Crt
5) Brain MRI and EEG
6) eye exam, hearing eval

16

What is the indicated therapy for neonatal HSV?

IV acyclovir (60mg/kg/day)

17

What is the recommended duration of ACV tx for SEM HSV?

14 days

18

What is the recommended duration of ACV tx for disseminated/CNS HSV?

21 days

19

When should CSF PCRs be checked?

for diagnosis and then conclusion of therapy

20

What is the recommended HSV suppression therapy?

300mg/m2/dose TID x 6 months

ANC should be assessed at 2-4 weeks and then monthly

21

What is typical for an early onset (< 7dol) sepsis?

1) maternal complications are common
2) prematurity (25%)
3) source of organism is usually genital tract
4) no typical clinical presentation or RDS
5) mortality 5%-15%

22

What is typical for an late onset (>7-89 dol) sepsis?

1) maternal complications are less common
2) prematurity not usually a factor
3) source of organism is usually genital tract or nosocomial or community
4) typical clinical presentation is focal
5) mortality 2%-10%

23

What is typical for an late onset (> 89 dol) sepsis?

1) maternal complications are common
2) birth weight < 1kg
3) source of organism is usually nosocomial or community
4) typical clinical presentation is focal
5) mortality 5%-60%

24

How does early onset sepsis typically present?

with fulminant multiorgan disease; often pneumonia