| ID | 362 |
|---|---|
| Name | NEONATAL INFECTIONS |
| Cause | Neonatal sepsis can be caused by bacteria such as Escherichia coli (E coli), Listeria, and some strains of streptococcus. Group B streptococcus (GBS) has been a major cause of neonatal sepsis. However, this problem has become less common because women are screened during pregnancy |
| Signs Symptoms | Symptoms of infection in newborns aren't very specific and may include Persistent crying, irritability, sleeping more than usual, lethargy, refusing to take the breast or bottle, low or unstable body temperature, jaundice, pallor, breathing problems, rashes, vomiting, or diarrhea |
| Diagnosis | as per symptoms |
| Investigations | Initial Workup of Suspected Neonatal Sepsis. Initial, nonspecific testing (eg, urine cultures, white blood cell [WBC] counts) may prove useful for identifying infants with a low probability of developing sepsis, but not for identifying infants likely to be infected |
| Management | Historically, the treatment approach for suspected neonatal sepsis has included early aggressive initiation of antibiotics because of the neonate’s relative immunosuppression. Because early signs of sepsis in the newborn are nonspecific, diagnostic studies are often ordered and treatment initiated in neonates before the presence of sepsis has been proven. Moreover, because the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the Centers for Disease Control and Prevention (CDC) all have recommended sepsis screening or treatment for various risk factors related to group B Streptococcus (GBS) infections, many asymptomatic neonates now undergo evaluation and are exposed to antibiotics. This approach has been questioned in recent years as more evidence emerges on the deleterious impact of unnecessary antibiotic exposure, including interference with the establishment of breast feeding, alternations in gut microbiome, increased incidence of childhood obesity and development of antimicrobial resistance amongst others. Furthermore, amongst very low birth weight infants who were initially treated with antibiotics but subsequently proved to have negative cultures, there was an increased risk of mortality and stage 3 retinopathy of prematurity |
| Introduction | Neonatal infections may be defined as the infections of the newborn baby acquired in utero during pregnancy (about 2%). during delivery & in the first 28 days of life (about 10%). |
| History | |
| Etiology | Neonatal sepsis can be caused by bacteria such as Escherichia coli (E coli), Listeria, and some strains of streptococcus. Group B streptococcus (GBS) has been a major cause of neonatal sepsis. However, this problem has become less common because women are screened during pregnancy |
| Clinical Features | Signs and symptoms of neonatal sepsis can range from nonspecific or vague symptoms to hemodynamic collapse. Early symptoms may include irritability, lethargy, or poor feeding. Others may quickly develop respiratory distress, fever, hypothermia or hypotension with poor perfusion and shock |
| Preventions | Things that can help prevent sepsis include: Preventing and treating infections in mothers, including HSV. Providing a clean place for birth. Delivering the baby within 12 to 24 hours of when the membranes break (Cesarean delivery should be done in women within 4 to 6 hours or sooner of membranes breaking.) |
| Treatment | Treatment for sepsis in newborns may include: Intravenous (IV) fluids. IV antibiotics to fight bacterial infections. Antiviral medication to fight viral infections. Heart and/or blood pressure medications. Extra oxygen and other forms of respiratory support, if needed. |
| Complications | Infection of the membranes surrounding the brain (meningitis) |
| Prognosis | |
| Types | Pneumonia, sepsis, and meningitis |
| Classification | Classification: The common neonatal infections are usually classified into two groups. Major & Minor infections- A. Major infections: Those infections, which endanger life. Such as- 1. Generalized infection-Neonatal sepsis/or septicemia. 2. Confined to one system-a. Neonatal Pneumonia - cong. or intra uterine pneumonia. - Aspiration pneumonia - Staphylococcal pneumonia. - Streptococcal pneumonia, b. Epidemic diarrhoea of newborn, c. Pyogenic meningitis, d. Pyelonephritis, e. Acute osteitis, f. Tetanus neonatorum. B. Minor infections: Those infections, which usually not endanger patients life. Such as- 1. Infections of skin & areolar tissue, viz: a. Staphylococcal septic spots & pustules, b. Pemphigus neonatorum or bullous impetigo. c. Paronychia (finger infection by staph). d. Breast abscess of newborn. 2. Ophthalmia neonatorum (conjunctivitis) 3. Umbilical sepsis. 4. Moniliasis (thrush). Another classification: A. Early onset disease: Disease menifests within the first week of life, but infection develops usually < 72 hours of birth & presents as a fulminant process involving multiple organs. The organisms are acquired from-maternal transmission, infected amniotic fluid, & from birth canal. Common organisms are- e.g, E. coli, H. inftuenze, Streptococai. B. Late onset disease: Disease usually menifests within 8-28 days of life. The organisms or infection may acquire from the hospital sources or from the community usually through attendants, i.e nosocomial sources. The common responsible organisms are- e.g, Staph. epidermidis, E. coli, Klebsiella, Pseudotnonas, Proteus etc. C. Late, late onset: Disease onset within 1-6 months. Infecion sources, usually nosocomial or community acquired; organisms are- e.g, Staph. epidermidis, E. coli, Candida etc. |
| Observation | |
| Pathology |
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