Neonatal Sepsis

Armanian Amir Mohammad , MDNeonatologist

Assistant Professor of Isfahan Faculty of Medicine

Sepsis neonatorum is the term used to describe

any systemic bacterial infection

documented by a

Positive blood culture in the first month of life .

SYMPTOMS AND SIGNS

•The signs and symptoms of neonatal

sepsis often are nonspecific

CLINICAL MANIFESTATIONS •level of Activity

CLINICAL MANIFESTATIONS •Pattern of Feeding

Abdominal distention / lavage… /

•muscle Tone

CLINICAL MANIFESTATIONS

CLINICAL MANIFESTATIONS

•level of Alertness

respiratory status or effort (Breathing)

CLINICAL MANIFESTATIONS

CLINICAL MANIFESTATIONS

•Peripheral Perfusion

CLINICAL MANIFESTATIONS •level of Activity

•Pattern of Feeding

•muscle Tone

•level of Alertness

•respiratory status or effort (Breathing)

•Peripheral Perfusion

•The negative predictive value (NPV) of this scoring system was 96%

•Thus, although observational findings alone cannot replace the physical examination and

laboratory studies, they are an important aspect of the evaluation.

•Temperature elevation in full-term infants is

uncommon .• Temperature elevation is infrequently

associated with systemic infection when only a single elevated temperature occurs  .• Temperature elevation that is sustained

longer than an hour is frequently associatd with infection  .• Temperature elevation without other signs of

infection is infrequent

Early-onset disease•GBS, E. coli and other gram-negative enteric bacilli, and

L. monocytogenes:

ampicillin + an aminoglycoside (gentamicin)

Multidrug-resistant bacteria: tobramycin and amikacin. (Ampi + Amika )

If meningitis is suspected: cefotaxime, for better CNS penetration.

( Ampi + Amika + Cefo)

ampicillin - g

entamicin

)

late-onset disease ( community acquired)

•Empirical therapy for late-onset disease acquired in the community should provide coverage for

the same neonatal pathogens of early onset and for potential community

acquired pathogens, such as S. pneumoniae ,N.meningitidis & H.influenza.

Because meningitis frequently is a component of late-onset sepsis, antibiotics with good CNS

penetration should be selected. Ampicillin and a third-generation cephalosporin

(e.g., cefotaxime) are commonl recommended.( Ampi + cefo)

Ampicillin - Cefotaxime

late-onset disease (nosocomial acquired)

•CONS, enterococci, gram-negative enteric bacilli (including drug-resistant strains), and fungi:

•Vancomycin generally is active against all staphylococcal species, streptococci, and most enterococci.

•Vancomycin and gentamicin are commonly used for initial therapy: (Vanco + genta or Amika )

•when gram-negative meningitis is a concern:

(Vanco + Cefo) Cefotaxime does not have activity against Pseudomonas, enterococci ,L.

monocytogenes. : PEL

Ceftazidime (Vanco + Cefta )

Vancomycin-Cefotaxime