Neonatal Sepsis : Definition, Etiology, Risk Factors, Pathophysiology, Signs, Symptoms, Complications, Diagnosis, Treatment, Care Plan, & Prevention
Definition
- Neonatal Sepsis is defined as presence of signs & symptoms of deep seated systemic infection in a neonate with or without bacteremia.
What conditions are included in neonatal sepsis?
- Neonatal pneumonia
- Neonatal septicemia
- Neonatal meningitis
- Neonatal UTI etc.
What are not sepsis?
- Conjuctivitis
- Oral thrush
- Few pustules
- Omphalitis
Types
1. Early onset (If onset within 72 hours of birth)
Source of infection
- Maternal genital tract
- Local delivery room
2. Late onset (If onset after 72 hours of birth)
Source of infection
- Hands of caregivers (Most common cause overall)
- Local nursery environment
Risk Factors
- Male child
- Preterm
- Low birth weight baby
- Intrauterine growth restriction (IUGR)
- High grade maternal fever during labour
- Prolonged rupture of membrane (>24 hour)
Etiology
1. Mostly bacterial
World
- Most common causes: Group B Streptococcus (Strep. agalactiae) > E. coli > Klebsiella
India
- Most common causes: Klebsiella > Staphylococcus aureus > Pseudomonas > E. coli
2. Rarely fungal
- Most common cause: Candida parapsilosis
Note: If sepsis is associated with conjunctivitis then most common cause is chlamydia.
Clinical Features
Non specific
- Poor feeding
- Lethargy
- Hypothermia > Fever
- Sclerema (Thick leather like texture of neonatal skin) ⇒ Fulminant sepsis
Organ specific
- Respiratory system: Tachypnea, Chest retractions, Cyanosis
- CVS: Shock, Pulmonary edema
- CNS: Seizures, Coma
- Metabolic: Hypoglycemia, Hyperbilirubinemia, metabolic acidosis
Investigations
1. Septic screen
Five parameters considered
⇓
Any Two Positive
⇓
Positive septic screen
5 parameters are:
- TLC ⇒ Leucopenia (< 5000/mm3)
- ANC (Absolute neutrophil count) ⇒ Neutropenia (<1800/mm3)
- Micro ESR ⇒ ↑ (>15 mm/hr)
- CRP ⇒ ↑ (> 1 mg/dl)
- I:T (Immature neutrophil : Total neutrophil) ⇒ ↑ (>20%) ⇔ Band cell proportion
2. Blood culture ⇒ Gold standard investigation
3. Lumbar puncture → CSF analysis ⇒ Suspected meningitis
4. CXR ⇒ Suspected pneumonia
5. Serum procalcitonin ⇒ ↑ in bacterial spesis
Treatment
A. Bacterial sepsis
Treatment of choice: Empirical IV Antibiotic treatment
Duration of treatment
- Only clinical features ⇒ 3-5 days
- Positive septic screen ⇒ 5-7 days
- Positive blood culture ⇒ 10-14 days
- Meningitis ⇒ 21 days
B. Fungal sepsis
- Antifungal drugs
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