Neonatal Sepsis

Dr. Walid Abdel Wahab

11th Lecture
:Done By
Amal Sahare Assayed

Amal Sahare Assayed

Newborns specially pre-term

infants have low immunity. So,
..simple infection is serious
In adults, skin infection for
instant is will localized and results
only in abscess, while skin
infection in newborn is serious
wide spread of the organism to
the blood leading to bacteremia
..that causes neonatal septicemia
So, neonatal infection is
generally serious and should be
treated well e.g. one of the simple
infection for newborn infection is
the umbilical cord infection. As
you know after delivery cutting of
the umbilical cord there is short
stump called the umbilical stump.
Infection of the umbilical stump
can be serious. Also, infection of
the Napkin Area or Napkin
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Dermatitis around the genetalia is

serious in newborns and develop
Napkin Dermatitis or Napkin Rash.
Also, Candida infection can lead
..to Candedemia
So, early detection and proper
..treatment are essential
Neonatal Septicemia
Sepsis is a major cause of
morbidity and mortality during
the neonatal period despite of
the use of potent antibiotics
..and intensive supportive care
It represents 50-80 % of
admission to NICU especially in
developing countries and it
reflects the degree of care of
the unit. Things that also
reflect the degree of the unit
care is the number of sepsis
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outbreaks ((i.e. wide spread

..infection to the whole unit))
It occurs at any level of NICU
((3 as ACH, 2 as AGH and level
1 as Primary Health Care
Units)). Infections increase in
pre-term infants and low birth
..weight
:Normal Birth Weight
kg 2.5-3.5
:Low Birth Weight
kg 2.5-1.5
:Very Low Birth Weight
kg 1.5-1
Less than 2.5 more liable to
develop infection than those of
..normal birth weight
:Morbidity & Mortality
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High. 9% of full-term duo to

maternal infection will develop
neurodevelpmental delay and
CP. 1\3 of neonatal sepsis will
..develop meningitis
:Definition of bacteremia
Presence of the bacteria in the
..blood
:Definition of Septicemia
Sepsis is severe infection of
the newborn characterized by
+ve blood culture (Bacterial or
fungal, ..) + multiorgan
..affections
:Types of neonatal sepsis
Depending on the time of the
.occurrence of the infection i.e
Early onset: 1st 72 hours of ..life
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..Late onset: 3-30 days of lifeLate..Late onset: 1-3 months of life ((new classification
because, they stay for a long
time in the nursery)) i.e.
extreme low birth weight and
pre-term infant they will stay in
..the nursery for long period
:Mood of Transmission
The early onset sepsis is through the mother either
transplacental or during birth
transmission through the
genital tract ((during labor))
some have colonization in the
vagina so, during vaginal
delivery there 'll be
transmission of the infection
through the genital tract and

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the baby 'll develop early onset

..infection
The late onset transmission hospital infection ((nosocomial
infection)) or community
..acquired
The importance of this
classification is essential for
treatment and detection of the
:organism's type
:Early onset sepsisGram +ve : GBS.. MCQ-1
,E-coli-2
,Klebsiella-3
..Listeria monocytogenes-4
:Late onset sepsis,G +ve: Staph. Aureus-1

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G ve : It depends in the unit-2

..((in ACH Enterobacter))
Maternal Risk Factors that
:cause early onset
:Chorioamnionitis-1
Infection of the amniotic
membrane around the fetus
((signs of chorioamnionitis in
the mother including: vaginal
discharge, abdominal
tenderness and fever before
..delivery))
Prolonged rupture of -2
membrane ((PRM)) more than
..18 hours
Maternal colonization ((the -3
commonest cause of maternal
colonization during pregnancy
is GBS)) but, in ACH not
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common ((the commonest in

..ACH G-ve Bacilli))
:Neonatal Risk Factors
,Pre-term infants-1
Immunocompromised full--2
,term newborns
,Long period of admission-3
,Low birth infant-4
,IV devices-5
Prolonged use of wide -6
spectrum antibiotics ((develop
..resistance and candediasis))
..Exposure to infected infants-7
Diagnosis of Septicemia
:((Septic Work Up))
:Clinical Manifestations
Sepsis .. Pneumonia .. ..Meningitis
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:No specific manifestations

:Generalfever or hypothermia
poor feeding
lethargy ((Not doing well))
:CNSconvulsions
lethargy or coma
:CVStachycardia or bradycardia
septic shock or hypotension
:RespiratoryTachypnea, apnea
and cyanosis
:GITVomiting, distension, diarrhea
and HSM
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:RenalOliguria
:HematologicalAnemia, bleeding and jaundice
:SkinColdness, sclerema and edema
:Complications of Septicemia
,Meningitis-1
,Pneumonia-2
,Septic shock-3
Multi organ dysfunction -4
failure ((renal, cardiac,
..respiratory, hepatic or DIC))
Investigations ((sepsis work
:up))
:CBC-1
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Sepsis causes bone marrow

: depression which leading to
Anemia, pancytopenia,
thrombocytopenia ((if the
platelets less than 100,000))
and leucopenia ((less than
..5000))
Increase the immature -2
..neutrophils ((IE ratio))
..CPR: +VE-3
..ESR: High-4
Coagulation profile: PT & PTT-5
..also prolonged
:Blood culture-6
Blood, CSF, urine, stool,
..umbilical swab
.P.S
:Contraindication of CSF
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Severe thrombocytopenia till

the baby receive platelets
transfusion.. MCQ
Q:What is the best sample of ??..urine culture
:AnswerSuprapubic tapping is the *
best (( 0n newborn the bladder
is a pelvic organ. If the bladder
is filled with urine insert a
syringe and extract a sample
for culturing)) if it failed use In
& Out catheter.. MCQ
Never use urine collection *
bag because, it may give false
+ve result duo to
..contamination
:Renal function test-7
..Urea and creatinin
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:Liver function test-8

..S. Bilirubin, SGOT and SGPT
:Blood gases-9
Ph, Pa O2, Pa Co2, Hco3
..((ACIDOSIS))
.P.S
The most important reliable
..investigation in sepsis is CBC
:Prevention of sepsis
Treatment of the colonized or infected mother by IV
,Ampicillin before delivery
Avoid nosocomial infection by following the infection control
,policy of NICU
The most important single factor to decrease infection in
..NICU is (HAND WASHING)
Amal Sahare Assayed

No prophylactic antibiotics for ..newborn infants

:Treatment including
:Initial empiric IV antibiotics
:Early-onset
..(Ampicillin + Gentamycin)
:Late-onset
..(Flucloxacillin + Gentamycin)
Change or continue the
antibiotics according to the
..culture and sensitivity
Repeated blood culture after
48 hours if the result is ve
((proper treatment)) but , if it
stills +ve 1st check the dose of
the antibiotic ((give the
maximum doses always)) but,
if the dose is proper change
the treatment or use
Amal Sahare Assayed

combination treatment
((augmentation TTT)) to
..increase the synergistic effect
Duration of therapy :will be
,-D for Gm+ &7 D for Gm 10days after the culture 7,become Ve
At least 3 weeks in ..meningitis
:Supportive Treatment
,IV fluid,O2 therapyCorrection of metabolic acidosis by sodium
,bicarbonate
Nasogastric feeding ((oral not ,contraindcation))
,IV immunoglobulinAmal Sahare Assayed

Blood transfusion, fresh frozen..plasma

:Prognosis of neonatal sepsis
:Complications of sepsis
Meningitis, Ventriculitis, Brain abscess, Mental retardation
..and cerebral palsy
Death 0ccurs in 20 25 % of cases due to multi-organ
..failure, DIC and septic shock
Candida Infection
:((Systemic Candidiasis))
:Etiology
C. albicans or C. parapsilosis..
((here C. albicans is the
..commonest organism))
:Risk factors
VLBW (< 1 kg), preterm,
prolonged use of antibiotics,
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intravenous lipid and fungal

..skin infection
:Clinical picture
..Same as sepsis
:Complications
Endocarditis, ophthalmitis and
UTI (( fungal ball in urinary
bladder that result in
hydroureter which diagnosed
..by ultrasound))
:Diagnosis
..blood, CSF and urine culture
Also, Echo and Ophthalmic
..examination
:Treatment
IV amphotercin B and
..Captovangene

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THE END

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Amal Sahare Assayed