B.Sc. NUrsing III year

1. Neonatal Sepsis
1R Dhaker, Lecturer, PCNMS

2. Introduction
• Neonatal Sepsis or sepsis neonatrum occurs
when pathogenic bacteria gain access into the
blood stream.
• They may cause overwhelming infection or
localize into lungs causing pneumonia or into
meaning causing meningitis.
• Neonatal Septicemia occurs in infants less than
90 days of age.
R Dhaker, Lecturer, PCNMS 2

3. Etiology
• A number of different bacteria including E. coli,
listeria and certain strains of streptococcus may
cause neonatal sepsis.
• Early onset neonatal sepsis most often appears
within 24 hours of birth.
R Dhaker, Lecturer, PCNMS 3

4. Cont… Etiology
• The following increase an infant’s risk of early
onset sepsis:-
– Group B streptococcus infection during pregnancy
– Preterm delivery and LBW baby
– Infection of placental tissue and amniotic fluid
– Multiple pervaginal examination
– Maternal fever and infection
• Babies with late neonatal sepsis get infected after
delivery by the organism thriving in the external
environment of the home or hospital.
R Dhaker, Lecturer, PCNMS 4

5. • The following increase infant’s risk of
developing late onset septicemia.
– Having an intracath in blood vessel for long time.
– Hospital stay for long time.
– Lack of aseptic technique following by care givers.
– Lack of breast feeding.
– LBW
– Superficial infection ( pyoderma, umbilical sepsis)
R Dhaker, Lecturer, PCNMS 5
Cont… Etiology

6. • Organisms that have been implicated in causing late-
onset sepsis include the following:
– Coagulase-negative Staphylococcus
– Staphylococcus aureus
– E coli
– Klebsiella
– Pseudomonas
– Enterobacter
– Candida
– GBS
– Serratia
– Acinetobacter
– Anaerobes
R Dhaker, Lecturer, PCNMS 6

7. Risk factors
• generally well-appearing
• previously healthy
– full term (at ≥37 weeks gestation)
– no antibiotics perinatally
– no unexplained hyperbilirubinemia that required treatment
– no antibiotics since discharge
– no hospitalizations
– no chronic illness
– discharged at the same time or before the mother
• no evidence of skin, soft tissue, bone, joint, or ear
infection
R Dhaker, Lecturer, PCNMS 7

8. Clinical Feature
• The manifestation of neonatal septicemia are
subtel, vague and non- specific.
• The most common compliant concerning infant’s
progress is “ failure to do well” or “ not looking
right”.
• Hypothermia is a common manifestation.
R Dhaker, Lecturer, PCNMS 8

9. The signs of sepsis are
non-specific and
include:
• Body temperature
changes
• Breathing problems
• Diarrhea
• Low blood sugar
• Reduced movements
• Reduced sucking
R Dhaker, Lecturer, PCNMS 9
• Seizures
• Bradycardia
• Swollen belly area
• Vomiting
• Yellow skin and whites
of the eyes (jaundice)

10. Cont… Clinical Feature
• Circulator system
– Pallor, cyanosis
– Cold, clammy skin
– Hypotension and
shock
– Edema
– Bradycardia or
tachycardia
R Dhaker, Lecturer, PCNMS 10
• Respiratory system
 Irregular
respiration , apnea,
 Cyanosis
 Grunting
 Dyspnea
 Retraction

11. Cont… Clinical Feature
• Central Nervous
System –
– Reduced activity
( lethargy , coma, poor
cry)
– Irritability , tremors
– Full fontanel
– Abnormal eye
movement
R Dhaker, Lecturer, PCNMS 11
• GI system-
• Poor feeding
• Vomiting
• Diarrhea or decreased
stool pass
• Abdominal distension
• Hepatomegaly

12. Cont… Clinical Feature
• Hematopoietic
system-
– Jaundice
– Pallor
– Ecchymosis
– Spleenomegaly
– Bleeding
R Dhaker, Lecturer, PCNMS 12
• Feature suggestive of
pneumonia include-
• Tachycardia
• Chest retractions
• Early cyanosis
• Poor feeding
• Lethargy

13. Diagnostic Evaluation
• Blood Culture
• Urine examination
• CSF study
• CBC
• C- reactive protein
• ESR may be elevated ( >15 mm 1st hour)
R Dhaker, Lecturer, PCNMS 13

14. Management
• For babies with neonatal sepsis,
–Supportive care and
–Antibiotic therapy
R Dhaker, Lecturer, PCNMS 14

15. Supportive care
• Provide warmth
• Start IV line. Infuse normal saline 10ml/kg over 5
to 10 minute.
• Infuse 10%glucose, 2ml/kg stat to manage
hypoglycemia.
• Administer injection vitamin K, 1mg IM to
prevent bleeding.
• If the baby is cyanosed or grunting provide
oxygen via hood or mask.
R Dhaker, Lecturer, PCNMS 15

16. Cont… Supportive care
• If baby is Apneic provide physical stimulation and
bag – mask ventilation, if required.
• Avoid oral feeding if baby is very sick and given
intravenous fluid.
• In neonates with sclerema, exchange transfusion
with fresh whole blood may be required.
R Dhaker, Lecturer, PCNMS 16

17. Antibiotic therapy
• Antibiotic therapy should cover common
causative bacteria like E.coli, staphylococcus
aureus and klebsiella pneumoniae.
• A combination of ampicillin and gentamycian is
recommended for treatment of sepsis and
pneumonia.
R Dhaker, Lecturer, PCNMS
17

18. Cont…Antibiotic therapy
IN Septicemia and Pneumonia
• Injection Ampicillin 50 mg/kg/dose 12 hourly IV or
IM 7 to 10 days
• Injection Gentamicin 2.5mg/kg/dose BD IV/IM, 7 to
10 days
In Meningitis
• Injection Ampicillin 100 mg/kg/dose 12 hourly IV 3
weeks
• Injection Gentamicin 2.5mg/kg/dose BD IV, 3Weeks
or
• Injection Chloramphenicol 12mg/kg/dose BD IV,
3weeks
R Dhaker, Lecturer, PCNMS 18

19. Prognosis
• The prognosis is variable. Sever neurological and
respiratory problem may occur in low birth weight
babies as a result of early onset sepsis.
• Late onset sepsis and meningitis may result in
poor outcomes.
R Dhaker, Lecturer, PCNMS 19