Contents
Bacterial bloodstream infection (BSI) (eg. meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of fever.
- M/imp cause of neonatal death in hospital as well as community in developing country
Aetiology
Early-onset sepsis (EOS): Less than 72 hr
Predominantly presents as pneumonia
- LBW babies
- Prolonged rupture of membranes (PROM)
- Foul smelling liquor
- Multiple par vaginum examinations
- Maternal fever
- Difficult/prolonged labour
- Aspiration of meconium
Late-onset sepsis (LOS): After 72 hr
Presents as septicemia/pneumonia/meningitis
- Lack of breastfeeding
- Poor cord care
- Superficial infections (eg. pyoderma, umbilical sepsis)
- Aspiration of feeds
- Disruption of skin integrity with needle pricks
- Use of IV fluids
Causative organisms:
- Commonly: E. coli, Staphylococcus aureus and Klebsiella sp.
- Hospital-acquired infections:
- Acinetobacter, Pseudomonas and coagulase-negative Staphylococci
Pathophysiology
Clinical features
Septicemia:
Overwhelming infection without much localization
- Refuses to suck
- Lethargic/unresponsive
- Poor cry
- Hypothermia
- Abdominal distension
- Vomiting
- Diarrhoea (rare)
- Apneic spells
Neonatal pneumonia:
Predominantly localized to the lung
- Fast breathing
- Chest retractions
- Grunt
Neonatal meningitis:
Predominantly localized to the meninges
- Excessive/high-pitched crying
- Fever
- Seizures
- Blank look
- Neck retraction
- Bulging anterior fontanel
Diagnosis
Neonatal sepsis screening:
Confirmatory if two parameters are positive:
- Total leukocyte count (TLC; <5000/mm3)
- Absolute neutrophil count (ANC; <1800/mm3)
- Immature to total neutrophil ratio (I/T ratio; > 20%)
- CRP (> 1 mg/ dl)
- Micro ESR (≥ 15 mm in the first hour)
CSF culture:
- Enterococcus spp.
- GBS
- Klebsiella pneumoniae
Blood culture:
- Klebsiella pneumoniae
Management
Supportive management:
- Warmth to baby
- Oxygen by hood/mask (cyanosis/grunting)
- Bag & mask ventilation (inadequate breathing)
- Dopamine/dobutamine (inadequate perfusion)
- IV Glucose (hypoglycemia)
- Optimal nutrition
- IM Vitamin K IM (1 mg)
- Transfuse packed cells
Empirical antimicrobial therapy
When aetiological agent unknown
| Clinical situation | Septicaemia and pneumonia | Meningitis |
| Community-acquired; resistant strains unlikely | Ampicillin or Penicillin and Gentamicin (1st line) | Cefotaxime and gentamicin |
| Hospital-acquired or low-moderate probability of resistant strains | Ampicillin or Cloxacillin and Amikacin (2nd line) | Cefotaxime and amikacin |
| Hospital-acquired sepsis or high probability of resistant strains | Cefotaxime and amikacin (3rd line) | Cefotaxime and amikacin |