INTRODUCTIONInfections arecommoninthe new born period.The newborns poor resistanceresultsinsepticemiafrom localized lesions.Thevirusesofherpessimplexorcytomegalicinclusion disease, and toxoplasmosis which hardly affect the adult, can damage the new bornseriously. The delicate skin of the new born and the umbilicus serve as easy portals of entryfor the organisms, in addition to the respiratory tract and the oral route. Attendants and otherscaring for the new born often harbour staphylococci in their nares or nails. roplet infectionsfromattendants is another source. !owever in certain diseases like poliomyelitis anddiphtheria , the immunoglobulin Ig"is passively transmitted from mother to baby affordingprotection. !owever,theIg#fractionisnottransmittedfromthemothertothefetusandprobably the reason why $%coli and other "ram negative organisms cause generalized andover whelming infection.INCIDENCEThe &orld !ealth 'rganization estimates that more than ( million neonates die each year and)*+ of these deaths occur in developing countries. Infections are among the main causes ofneonatal mortality. The neonatal health is intrinsically linked to the mother,s health and thecare she receives before, during and immediately after delivery. If in resource%rich countriesimprovements in perinatal conditions, prevention and management of fetal%neonatal infectionshave reduced the burden of neonatal morbidity and mortality, in resource%limited areas theyhave only -ust improved and many barriers remain still to be overcome. .rematurity is oftendue to fetal infections and represents a significant risk factor for nosocomial infections. PREDISPOSING FACTORS low birth weight.reterm babies are more susceptible to develop infection due to deficient humoral and cellularimmune mechanisms. Their exposure to warm and humid atmosphere ,respirators,resuisitorsand catheters is conductive to the development of infections. contaminated in utero environment.rolonged rupture of membranes, unhygienic and multiple vaginal examinations, prolongedlabor,and poorpersonalhygiene lead to asending infection oftheamniotic fluid which isgood culture medium for bacterial growth especially when it is contaminated with meconium infected birth passagesAnumberofbacterial andnonbacterial infectionsarecontractedbythebabyduringitspassage through the birth canal eg/"onococci,0isteria monocytogenase,$ coli,1treptococcushemolyticus, 2andidaalbicans,!erpis virus hominis,etc. 3early)4+of pregnant womenharbor potentially pathogenic organisms in their genital tract. 2horioamnionitis ischaracterized by maternal fever , pain, tenderness, in the uterus, foul smellingli5uor.leucocytosis and positive 26. infection at birthThe neonates not only have enhanced vulnerability to infections but they also have greateropportunities to get infected in the labor room and 3I27. !ands of personnel are a potentsource of microbes unless due precausions are taken. The high risk neonates are exposed to avarietyofformiteswhicharepotentialsourceofpathogensuchasincubators, cots, linen,suction and oxygen catheters, thermometers,endotrachealtubes, resuscitation e5uipment etc.The congestion andovercrowding in the nurseryare associated with increased riskofnosochomial infections. The lack of enough disposibles8small vein infusion sets, catheters9TYPES OF INFECTIONSThe infections may remain superficial and localized or the baby may develop fulminant anddisseminatedsystemic infection. uetoinabilityonthepart of theneonatetodevelopsufficient inflammatory response to localize the infection,it gets rapidly disseminatedespecially in the low birth weight babies superficial infections1uperficial infections are common and their incidence is related to the standard of hygieneand attitude of the personnel working in the maternity units. #a-ority of these infections arecausedby"rampositiveorganisms, 1taphylococcus aureus andalbus. Theinfectionisconveyed to the baby through contaminated hands of the nurses ,doctors, and relatives whomay be nasal carriers of 1taphylococci pyoderma.ustules are commonly seen on scalp,neck,groin,and axillae. These are more common duringthe summer months. Their fre5uency can be reduced considerably by routine application oftriple dye to the umbilical cord and hexachlorophene skin prophylaxis during epidemics. Thespread of infection may lead to formation of abscess ,parotitis osteomyelitis andseptisemia.0ife threatening staphylococcal infection may lead to manifestations of pemphigusneonatorum which is characterized by marked erythema,bullous lesions,and exfoliation givingan appearance of scalded skin syndromeOTHER TYPES Early onset infection..rematurityhasgot special challengeforcliniciansandalsoother medical staff, suchasmicrobiologists. Immature host defense mechanisms support early%onset sepsis, which can bevery serious with very high mortality. &hile the past decade has been marked by a significantdecline in early%onset group : streptococcal 8":19 sepsis in both term and preterm neonates,theoverall incidenceofearly%onset sepsishasnotdecreasedinmanycenters, andseveralstudieshavefoundanincreaseinsepsisduetogram%negativeorganisms. &ithincreasingsurvival of these more fastidious preterm infants. late onset infections3osocomial bloodstream infection 8:1I9 will continue to be a challenging complication thataffects other morbidities, length of hospitalization, cost of care, and mortality rates. $speciallythe very low birthweight 8;0:&9 infants sensitive to serious systemic infection during theirinitial hospital stay. 1epsis caused by multiresistant organisms and 2andida are also increasinginincidence, hasbecomethemost commoncauseof deathamongpreterminfants. Thisreview focuses on the clinical microbiology of neonatal sepsis, particularly among pretermbabies, summarizingthemost fre5uent bacterial andfungal organismscausingperinatallyac5uired and also nosocomial sepsis.CLINICAL FEATURES< 9!istoryThe predisposing factor may include active infection of the mother active infection of themother during pregnancy, prolonged rupture of membrane , pre mature or difficult deliveryand asphyxia at birth. It should be stressed that negative history does not preclude congenitalinfection.=91ymptoms and signs Infectionsinthenewbornaredifferent fromthoseencounteredinolder infantsandadults. >ever is not always present, being found only in half the cases. .oor feeding, pooractivity, -aundice andpoor weight maybetheonlysymptoms drawingattentiontothegeneralized infection ,especially in the pre matures .;omiting and diarrhea are sometimes duetoageneralizedinfectionapart fromgastrointestinal infection..allor accompanies theinfections while it lasts. 6apid breathing and even slight cyanosis may be found in some of theinfantswithsepticemia. #eningitis occursina5uarter offall septicemicbabiesbut, thespecific signs are oftenlacking8 stiffness of the neckbeingveryrare andthe bulgingfontanelle in only a third of proved meningitis cases 9. 2onvulsions are variable , and lumbarpuncture must be performed ineverybabysuspected of generalized sepsis to excludemeningitis ?9 Investigations and diagnostic findings&henever infection is suspected, the following investigations have to be carried out.a. :lood cultures%at least two specimens are taken where such facilities are available b. 2ulture swabs should be taken from umbilical cord base, throat, stools and urine when infection is suspected and before antibiotics are used c. The 21> is obtained and send for both bacteriological and biochemical examination d. 6outine blood counts chest x%ray and urine analysis e. "astric smear examination appear to be a simple , 5uick and reliable method for screeningbabies who are candidates for neonatal infection. The gastric contents are aspirated an hourafter birth using a sterile rubber catheter and a sterile glass syringe. A drop of the gastric -uiceis placed on a clean glass slide while the reminder is send for culture and sensitivity tests. Asmear is made and stained with fresh leishmans stain . the number of cells per !igh .ower>ield are counted and a count more than @ cells 8!.>9 is considered diagnosticallysignificant . it is a very simple bed side clinical test which can be performed with out extrae5uipment or specially trained staffs.f. #icro $16 by collecting capillary blood g. AcutephaseproteinsA2reactiveprotein, alphaacidglycoprotein,haptoglobin, alphaantitrypsin and fibrinogen increased with inflammation where as pre albumin and transferrindecrease with inflammation .h. :andneutrophil tototal neutrophil count ratiosensitivityof*=%)4percent ofdetectingseptisemia andi. 0imulus lysate assay detects theendotoxin released by gram negative bacteria .$xpect culture and "ram stain ,other tests are indirect markers. This investigational exercise isknown as the1$.1I1 126$$3. BACTEREMICSHOCK (GRAM NEGATIVE SEPTICEMIA)

:acteremic shock sometimes goes unrecognized in the neonatal period.Theclinical patternis similar toshocklikestates inlater life8pallor, lowtemperature,collapse9.onlyautopsystudieshaverevealedthecorrect diagnosisintheseinfants. !enceroutine blood studies should be carried outin all infections.Septicemiaisthecommonest infectioninthenewborn, closelyfollowedbypneumonia,diarrhea and meningitis. The clinical picture is extremely variable, the striking feature beinglackof specificsigns andsymptoms, someof whicharelethargy, abdominal distension,vomiting, spells of cyanosis and irritability in addition to poor feeding and -aundice ,the latteroften ushered in by the second or thirdday. >ever is variable ,with severe infections showingsub normal temperatures.The common etiologic agent of the serious infections 8pneumonia, meningitis, diarrhoea, septisemia9 in the newborn is $ coli. 1econd in the fre5uency to $ coli is 1taphylococcus aureus of which some strains are resistant to the popular antibiotics. 1evere staphylococcal infections like pustules orbolis which may assume epidemic proportions in a nursery. Another important feature is that the serious forms of staphylococcal infections may occur after discharge from the nursery. 1ome strain of 1taphylococcus aureus appear to have unusual pathogenicity and once the organism has been introduced into the nursery by an adult,the spread is rapid."roup :streptococcal sepsis is particularly common in prematures. The respiratory picture inthis infection may be difficult to differtiate from hyaline membrane disease.Pseudomonas pyocyaneusis an important pathogen which affect prematures in particular.Theorganismcanproducesymptoms rangingfromvagueundefinedill healthtoseriousconditions like septisemia accompanied by -aundice,purpura,high temperature and death.Treatment/ maintenance of optimum temperature,oxygenation and fluid electrolyte balance isof primeimportance. Acontinuous intravenous dripof dopamineis ideal for combatingsepticemic shock.In the hypovolemic stage ,hydrocortisone should be started and replaced later bydexamethasone.The selection ofantibiotics ideally shoulddepandon the prevailing patternof entiologicalagentsandtheirsensitivitypattern. :yandlarge,thetrendeventodayistostart withacombinationof ampicillinandgentamycin.inarecent reviewof literature onsensitivitypatterns,in the last