Definition

• deep seated infection in neonates

Epidemiology

• 15.8 per 1000 live births
• preterm infants are at higher risk

Risk factors of sepsis

• preterm premature rupture of membranes
• prolonged rupture of membranes (>18h cloherty esp GBS, >24 hrs AIIMS protocol)
• pre-labor temperature of >38° C
• chorioamnionitis
  • Intrauterine inflammation or infection at birth (III)
  • defined by 1.Fetal tachycardia, 2.maternal leukocytosis >15000, 3.purulent fluid from cervical os, 4. biochemical changes in amniotic fluid consistent with infection 5.fever >39 C in mother
• group B streptococcus colonization
• previous surgery
• foul smelling liquor
• />3 per vaginal examination
• single unclean vaginal examination

Minor risk factors

• term male sex
• galacossemia
• congenital immune defects
• omphalitis
• obstructive uropathy
• outborn neonates
• need for artificial ventilation
• gestational age <37° C
• Premature rupture of membranes

organism that cause neonatal sepsis

Bacteria >> Fungi

Types of neonatal sepsis

EONS - onset of signs and symptoms in 72 hours
LONS - after 72 hours

source of infection

EONS - maternal genital infection, local delivery area
LONS - hands of caregivers (MC), local nursing environment

clinical features

• poor feeding, lethargy, Hypothermia > fever
• tachypnea, retraction, cyanosis, apnea, grunting
• CCF, arrythmia, shock
• altered sensorium, bulging Fontenelle, tone abnormality
• feed intolerance, vomiting, bleeding per rectum, NEC
• anemia, leucopenia, thrombocytopenia, bleeding
• hypoglycemia, hyperbilirubinemia, acidosis
• hyperglycemia can occur in fungal sepsis

causes of fever in newborn

• sepsis > 1hr
• dehydration fever
• CNS disorder
• familial dysautonomia
• radiant warmer malfunction
• hyperthyrodism
• ectodermal dysplacia

salmon pink papules - Listeria monocytogenes
Pseudomonas - ecthyma gangrenosum (in VLBW)
curdy white discharge -candida
pneumonia with conjunctivitis - staph aureus, conjunctivitis

s.aureus

• low TLC
• lobar or bronchopneumonia

C. trachomatis

• increased TLC
• interstitial infiltrates

Investigation

Charts for neutrophil count

• term - Monroe chart
• preterm - Mouzhino chart

blood culture - gold standard
LP - for late onset sepsis, if blood culture is positive

new markers - serum procalcitonin, serum amyloid A, CD64

Management

• supportive
  • feeding
  • hypovolemia 10ml/kg bolus
  • consider inotropes if septic shock develops despite fluid therapy
  • oxygen support
  • ventilator support
• specific therapy
  • antibiotics - parenteral
  • empirical antibiotics

empirical therapy

fungal sepsis

• common in LBW and VLBW, or if receiving broad spectrum antibiotics
• candida albicans > candida parapsilosis
• DOC - fluconazole
• meningitis - liposomal Ampho B
• all ELBW babies to be given fluconazole prophylaxis

Health care acquired infections

• CONS/S. epidermidis (world), klebsiella (India)
• CLABSI (central line associated blood stream infection) - CONS - high mortality 5-20%
• VAP (ventilator associated pneumonia)
• surgical site infection
• catheter associated UTI
• Recurrent MSSA - nasal mupirocin to reduce S. aureus carriage

Viral sepsis