NEONATAL

INFECTIONS

Mrs. Banita Rana

M.Sc (N) OBG
Nursing Tutor
SMVDCoN
 INTRODUCTION
• Infections of neonates during neonatal period are
called as neonatal infections. It is the most common
cause of mortality in India.
• Infections can occur in intrauterine life or during
delivery or in neonatal period.
• The neonates are more susceptible to infections
because they lack natural immunity and take some
time for development of acquired immunity
 NEONATAL INFECTIONS
• Invasion & uncontrollable growth of pathogenic
microorganisms in the body of neonate is known as
neonatal infection.
 CAUSES
ANTENATAL PERIOD (STORCH)
• S:- Syphilis
• T:- Toxoplasmosis
• O:- Other (Gonococci infections, Tubercular
Infections, Malaria, Varicella, Hepatitis B, HIV etc).
• R:- Rubella
• C:- Cytomegalovirus and
• H:- Herpes Simplex Virus
 CAUSES
INTRANATAL PERIOD
• Aspiration of infected liquor
• Due to repeated vaginal examination
• Infected birth passage
• Improper aseptic technique during care of umbilical
cord
 CAUSES
POSTNATAL PERIOD
• Transmission of infection from human contact or
care givers especially from infected hands of
mother or family members and health care
providers.
• Cross infection from other baby who is infected
• In case no barrier nursing is practiced
• Infected articles for baby care and contaminated
clothing.
• Invasive procedures without aseptic technique.
• Infected environment around the neonates at
hospital or home.
 PREDISPOSING FACTORS
• LBW
• Contaminated Intra Uterine environment.
• Infected birth canal & infection at birth.
• Procedures
• Artificial feeding
• Resuscitation
COMMON INFECTIONS IN NEONATE

Neonatal conjunctivitis

Umbilical sepsis

Oral thrush

Pyoderma

Neonatal Sepsis
 NEONATAL CONJUCTIVITIS
• Inflammation of conjunctiva during first three
weeks of life is termed as ophthalmic Neonatrum.
• Ophthalmic Neonatrum is swelling or infection of
tissue lining the eyelids in a newborn
 MODE OF INFECTION
• Infected hands
• Infected birth canal
• Cross infection from other infected infants.
 CLINICAL FEATURES
• Sticky eyes with or without discharge
• Watery or purulent or muco-purulent
• Swollen eyelids
• Redness in eyes
 DIAGNOSTIC STUDIES
• Culture of drainage from eye.
• Slit lamp examination
 MANAGEMENT
• Isolation
• Gentamycin or sulfacetamide drops or erythromycin
ointment can be used.
• For Gonococcal infection penicillin therapy should
be initiated.
• In case of penicillin resistance cefotaxime or
ceftriaxone are used.
• Cleaning of infected eye with sterile cotton swabs
soaked in saline.
• Instillation of eye drops be done.
OMPHALITIS
 UMBILICAL SEPSIS (OMPHALITIS)
Source of infection
• Unhygienic environment of delivery
• Umbilical catheterization
• Exchange transfusion
• Contaminated cord cutting instrument
• Infected hands of care giver
• Infected clothing
 CAUSATIVE ORGANISMS
• Staphylococcus
• E. Coli
• Clostridium tetani
 CLINICAL FEATURES
• Swollen and moist peri-umbilical tissue
• Redness
• Foul smelling
• Sero-purulent discharge
• Delayed falling off umbilical cord
• Fever
• septicemia
 MANAGEMENT
• Dressing of infected cord with spirit & antibiotic
ointment, powder or lotion.
• Isolation
• Culture & sensitivity test
 ORAL THRUSH
• It is a fungal infection of oral cavity and tongue by
Candida albicans.
 CAUSES
• Infected birth canal
• Infected feeding bottles
• Contaminated feeding articles
• Contaminated mothers hands & nipple.
 CLINICAL MANIFESTATIONS
• Milky white elevated patches.
• Oozing of blood
• Swallowing difficulties
• Sucking reflex may be normal.
 MANAGEMENT
• Oral application 0.5% aqueous solution of gentian
violet after each feed.
• Nystatin & ketoconazole lotion is effectively used 4
times per day for 5-7 days.
• Parenteral antifungal drugs
 PYODERMA
• It is the superficial skin infection usually caused by
Staphylococcus aureus.
 CLINICAL MANIFESTATIONS
• Skin erruptions and pustules seen in scalp, neck,
groin and axillae.
• Abscess
• Erythma
 MANAGEMENT
• Lesions are punctured and cleared with
hexachlorophene, antiseptic skin care and
application of antibiotic ointment.
• Pus should be sent for culture & sensitivity test.
• In case spread of infection, erythromycin 50 mg/kg
per day orally in 3 divided doses should be
administered.
• Isolation.
 NEONATAL SEPSIS
• Systemic bacterial infection of neonate is called
neonatal sepsis.
• When the pathogenic bacteria gain access in blood
stream they may cause overwhelming infections.
 CAUSATIVE ORGANISMS
• Klebsiella pneumoniae
• Staphylococcus aureus
• E. Coli
• Pseudomonas
 PREDISPOSING FACTOR
• Intrauterine infections
• Premature & prolonged rupture of membrane.
• Meconium stained liquor
• Repeated vaginal examination
• Maternal infection
• Lack of aseptic practices
• Low birth weight
• Invasive procedures
• Aspiration of feeds & lack of breast feeding.
 SOURCES OF INFECTION
• Infusion sets
• IV sets
• Face masks
• Feeding bottles
• Catheters
• Ventilators
• Resuscitators
• Incubators
• Contaminated articles.
 TYPES OF NEONATAL SEPSIS
• Early onset neonatal sepsis:- It develops before 72
hours of life due to intrauterine infections,
intranatal causes and maternal conditions.
• Late onset of neonatal sepsis:- It develops after 72
hours may be at the end of first week or second
week. Acquired as nosocomial infection from baby
care area.
 CLINICAL MANIFESTATIONS
CENTRAL
RESPIRATORY
NERVOUS
Apnea
SYSTEM
Bradycardia INTEGUMENTARY
Temperature
Grunting Jaundice
instability Pallor
Nasal flaring
Lethargy Petechiae
Retractions
Hypotonia
Metabolic
Instability
acidosis
seizures

Gastrointestinal
CARDIOVASCULAR Feeding
Decreased CO Intolerance
Tachycardia Abdominal
Hypotension
distention
Decreased
perfusion Vomiting
diarrhoea
 DIAGNOSTIC EVALUATION
• Blood investigations
• swab culture from septic umbilicus
• Lumbar puncture CSF.
• Urine for routine examination & culture
• Chest X-ray
• Blood sugar
• Serum bilirubin
• Leukocyte count
 MANAGEMENT
Supportive care
• Maintenance of warmth.
• IV fluid to be administered
• Dextrose (10%) 2ml/kg bolus to correct
hypoglycemia.
• Oxygen therapy
• Bag & mask ventilation with oxygen.
• Vit. K 1mg IM should be given
• Enteral feed should be avoided in case of abdominal
distension.
 MANAGEMENT
Antibiotic therapy
• Gentamycin/ amikacin
Duration of antibiotic therapy
• 7-10 days or 14 days in septicemia & pneumonia.
• 14 days for UTI
• 21 days for meningitis.
 MANAGEMENT
• Other antibiotics:- amoxicillin, cloxacillin,
ceftriaxone, ceftazidime, ciprofloxacin, cefotaxime,
vancomycin.
• Other drug therapy includes anticonvulsive
(diazepam or phenobarbitone),
• Dopamine to treat shock & mannitol in case of
increased ICP.
• Phototherapy & exchange blood transfusion in
hyperbilirubinaemia.