NEONATAL INFECTIONS AND
CONDITIONS
FAITH
NEONATAL INFECTIONS I
NEONATAL SEPSIS
OBJECTIVES
1. To understand the definition and
classification of the term neonatal
sepsis.
2. To review the risk factors, clinical
presentation, investigations, treatment
and follow up for babies with neonatal
sepsis.
Neonatal sepsis
Definition:
-Is defined as the presence of a serious
bacterial infection such as meningitis,
pneumonia, pyelonephritis, or
gastroenteritis in the setting of fever
occuring in the first 30 days of life.
-Also includes serious fungal and viral
infections.
Classification
• Neonatal Sepsis is categorised as:
- early onset presenting at 48-72hrs of
life
- late onset: with symptoms
presenting at 4-90 days of life
ENOS -Risk Factors
1. Maternal colonization with microorganisms.
This leads to:
-Transplacental infection if mother has
bacteraemia
- an ascending infection from the cervix may
be caused by organisms that colonize in
the mother's genitourinary tract
-acquisition of the microbe by passage
through a colonized birth canal at delivery
especially GBS
EONS - Risk factors cont...
- premature rupture of membranes
(PROM)
- preterm rupture of membranes
- prolonged rupture of membranes
- maternal urinary tract infection
- Chorioamnionitis –maternal fevers, foul
smelling liqour
- Prematurity
ENOS- causative organisms
The microorganisms most commonly
associated with early-onset infection include:
- Group B Streptococcus (GBS)
- Escherichia coli
- coagulase-negative Staphylococcus
- Haemophilus influenzae
- Listeria monocytogenes
NB:
Pneumonia is more common in EONS
LONS - Risk factors:
-contamination from the caregiving
environment especially due to lack of or
poor hand washing techniques
- vascular or urinary catheters, other
indwelling lines
-prematurity
-central venous catheterization (duration
of >10 days)
CONT..
-nasal cannula or continuous positive
airway pressure (CPAP) use
-H2 blocker/proton pump inhibitor use
-gastrointestinal tract pathology
NB: Meningitis and bacteraemia are more
common in LONS
LONS - Causative organisms
- coagulase-negative staphylococci
- Staphylococcus aureus
- E coli
- Klebsiella
- Pseudomonas
- Enterobacter
- Candida
CONT..
- GBS
- Serratia
- Acinetobacter
- anaerobes
- coagulase-negative Streptococcal sepsis
Other causes:
• Meningoencephalitis and neonatal sepsis syndrome
can also be caused by infection with:
-adenovirus,
-enterovirus, or
-coxsackievirus.
-sexually transmitted diseases (eg, gonorrhea, syphilis,
herpes simplex virus [HSV], cytomegalovirus [CMV],
hepatitis, human immunodeficiency virus [HIV],
rubella, toxoplasmosis
-Trichomonas vaginalis,
-Candida species
Clinical presentation
• The clinical signs of neonatal sepsis are nonspecific
and are associated with characteristics of the
causative organism and the body's response to the
invasion.
• These signs are associated with other neonatal
diseases such as
- respiratory distress syndrome (RDS)
- metabolic disorders
- intracranial hemorrhage
- traumatic delivery
Clinical presentation cont..
• Tachypnea, irregular respirations,
moderate retracting, apnea, cyanosis, and
grunting may be observed in congenital
pneumonia or postnatally acquired
pneumonia.
• Cardiac signs: In overwhelming sepsis,
pulmonary hypertension, decreased
cardiac output, and hypoxemia may occur
in the initial phase.
Clinical Presentation cont..
• Metabolic signs: Hypoglycemia,
hyperglycemia, metabolic acidosis, and
jaundice.
• Temp instability: hyper or hypothermia
• Neurologic signs: Meningitis is the
common manifestation of infection of
the CNS.
NB on Meningitis
Meningitis due to early onset neonatal sepsis usually
occurs within 24-48 hours and is dominated by
non-neural signs. Neurologic signs may include
stupor and irritability.
-Meningitis due to late-onset disease is more likely
to demonstrate neurologic signs (80-90%).
Impairment of consciousness (ie, stupor with or
without irritability), coma, seizures, bulging
anterior fontanel, extensor rigidity, focal cerebral
signs, cranial nerve signs, and nuchal rigidity occur.
Cont..
GIT signs: swallowed meconium
NEC: multifactorial
LABS
• Septic screen:
-total blood count and differential count
-Immature to total ratio (I/T) ratio
-microscopy culture and sensitivity:
-urine
-stool
-CSF
-Blood
-serial C- reactive Protein
Imaging
• Chest radiography- pneumonia/pleural
effussion
• CT scan or MRI may be needed late in
the course of complex neonatal
meningitis to document obstructive
hydrocephalus or infarcts
• Head ultrasonography in neonates with
meningitis may reveal the progression of
complications
Treatment
• When neonatal sepsis is suspected,
treatment should be initiated
immediately because of the neonate's
relative immunosuppression.
• To treat ENOS :combined intravenous (IV)
aminoglycoside and expanded-spectrum
penicillin antibiotic therapy..
Treatment cont...
• If an infection is nosocomial, antibiotic
coverage should be directed at organisms
implicated in hospital-acquired infections,
including S aureus, S epidermis, and
Pseudomonas species.
• Most strains of S aureus produce beta-
lactamase, which makes them resistant to
penicillin G, ampicillin, carbenicillin, and
ticarcillin. Thus Vancomycin is preferred.
Treatment cont...Meningitis
• Infants with bacterial meningitis require
higher dosages of antibiotics and longer
courses of treatment.
• These infants may also require an
antimicrobial that has better penetration
of the blood-brain barrier to achieve
therapeutic drug concentrations in the
CSF.
CONT..
• Continue antibiotics for a minimum of 2
weeks for gram-positive meningitis and 3
weeks for gram-negative meningitis.
• Surgical intervention:
-Abscess
-Hydrocephalus
- CVP line insertion
FOLLOW-UP
• If neonatal sepsis was associated with
meningitis, prolonged hypoxia,
hydrocephalus or brain abscess
formation, the infant should be observed
for several years to assess their
neurodevelopment and should receive
appropriate early intervention services
and therapies when appropriate.
questions
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Summary
• A high index of suspicion is needed to avoid
missing neonatal sepsis
• Comprehensive history taking to obtain
maternal risk factors is vital
• Appropriate workup, treatment and follow-up
are key to successful management of the
infected neonate.
