1. Neonatal Septicemia Li Yijuan First Affiliated Hospital SUMS

2. Will They Have Good Future ???

3. Objectives What will I learn? Etiologies and risk factors Symptoms Diagnosis Treatment

9. Staphylococcus

10. E. Coli

13. Klebsiella

15. Group B -hemolytic streptococcus

19. What makes a neonate’s immune system susceptible to sepsis? Maturity Immaturity or

20. You’re Right!!!! The immaturity of a neonate’s immune system makes them MORE SUSCEPTIBLE to sepsis.

21. Why are newborns so vulnerable to infection? Non-specific immunity Specific immunity

22. Why are newborns so vulnerable to infection? IMMUNE SYSTEM Neutrophils – Qualitative and quantitative Complement and immunoglobulin levels decreased T cells- antigenically naïve limited cytokine production

27. Clinical menifestations EOS LOS Onset Within 7 days >7 days Source Prenatal During delivery During delivery Postnatal(nosocomial ) Pathogens G - bacili S taphylococcus ; Opportunitic P resentation Mortality P neumonia High Bacteremia and / or meningitis Low

28. Symptoms of Neonatal Sepsis The symptoms are not concrete and vary widely Tachypnea Heart Rate Changes Feeding difficulties Difficulty Breathing Temperature Instability J aundice Irritability

29. Omphalitis

30. Bleeding tendency Poor perfusion

31. Enlargement of liver and spleen

32. toxical paralytic ileus

33. NEC

34. NEC

35. dyspnea

36. Clinical presentation Early warning signs are often non-specific and subtle  easily confused with non-infective causes (e.g. apnea of prematurity, variation in environmental temperature or acute exacerbation of chronic lung disease)  clinical course alarmingly fulminant  septic shock + DIC  death Non-specific, multi- systems/organs involved

37. Clinical manifestation The symptoms are so broad , non-specific , and acute deterioration , How to make a diagnosis as early as possible ?

40. Reference values for neutrophilic cells Manroe BL, J Pediatr 1979;95:89-98.

41. Total neutrophils Immature neutrophil I/T ratio

44. Lab Exam: Organism detection  blood culture  culture of body fluid and secretion  plasma brown layer smear --Detection of antigen: usually for antibody of GBS or E coli in CSF, blood and urine --Molecular biochemical method PCR

45. Summary Is there a diagnostic marker for neonatal sepsis?

50. Treatment  Antibiotics therapy  management of complications  supporting therapy  Clearance of infectious focus  Immunotherapy

52. Dosages of antibiotics for newborns

57. Thank you for your attention