Atualização em Sepse Neonatal – Precoce e Tardia

Summary

In this educational videocast, Dr. Carlo Magno, a pediatrician and neonatologist, delves into neonatal sepsis, a key topic for medical exams in pediatrics and neonatology. He explains the distinction between early and late neonatal sepsis, the main etiological agents involved, and practical clinical considerations. Dr. Magno highlights risk factors like maternal infection, premature birth, and prolonged rupture of membranes. He also discusses the importance of timely diagnostics, including the role of prophylactic antibiotics for at-risk mothers. Throughout, he emphasizes the latest guidelines and strategies, including those from the CDC and the Brazilian Pediatric Society, ensuring a comprehensive and up-to-date approach for exam preparation.

Takeaways

• 😀 Neonatal sepsis is classified as either early or late, depending on the timing of its onset. Early sepsis occurs within the first 72 hours, while late sepsis occurs after 72 hours.
• 😀 The primary pathogens responsible for early neonatal sepsis are Group B Streptococcus, E. coli, and Listeria monocytogenes.
• 😀 Late-onset neonatal sepsis is typically caused by hospital-acquired pathogens, including Staphylococcus epidermidis, Staphylococcus aureus, and various gram-negative bacilli like Klebsiella, Serratia, and Pseudomonas.
• 😀 A simple mnemonic to remember the pathogens: 'P' for 'Precoce' (early) and 'Streptococcus', and 'T' for 'Tardia' (late) and 'Staphylococcus'.
• 😀 Streptococcus group B is the most significant risk factor for early neonatal sepsis, and mothers are tested for this during pregnancy between 35-37 weeks.
• 😀 If a mother is colonized with Group B Streptococcus and doesn't receive appropriate intrapartum prophylaxis, the neonate may be at increased risk of sepsis.
• 😀 Premature infants, or those born to mothers who did not receive full prophylaxis, should undergo testing for infection within the first 12-24 hours of life.
• 😀 If a baby is born via elective cesarean section with intact membranes and has no signs of infection, no need for further testing for Group B Streptococcus.
• 😀 In cases of chorioamnionitis, infants should be transferred to a neonatal unit, undergo blood cultures, and receive empirical antibiotics until sepsis is ruled out.
• 😀 Premature rupture of membranes (PROM) greater than 18 hours poses an infection risk, especially in the absence of labor, as it may indicate the presence of pathogens like Group B Streptococcus.
• 😀 Clinical signs of neonatal sepsis include hypoactivity, apnea, feeding intolerance, abdominal distention, and hyperglycemia. These symptoms require further testing to confirm sepsis.
• 😀 Early neonatal sepsis rarely causes hemodynamic instability, but late-onset sepsis, especially from hospital-acquired pathogens, is more likely to cause instability or shock.

Q & A

What is the primary distinction between early and late neonatal sepsis?

The primary distinction is the time of occurrence. If the sepsis occurs within the first 72 hours of life, it is considered early neonatal sepsis. If it occurs after 72 hours, it is considered late neonatal sepsis.

What are the common etiological agents of early neonatal sepsis?

The most common etiological agents of early neonatal sepsis are Group B Streptococcus (Streptococcus agalactiae), Escherichia coli (community-acquired), and Listeria monocytogenes, though Listeria is rare.

What causes late neonatal sepsis and how is it different from early sepsis?

Late neonatal sepsis is caused by hospital-acquired bacteria, not maternal flora. Common agents include Staphylococcus epidermidis (coagulase-negative staphylococcus), Staphylococcus aureus (coagulase-positive), and various Gram-negative bacilli such as Klebsiella and Pseudomonas.

How can one remember the agents responsible for early and late neonatal sepsis?

A simple mnemonic is to associate 'P' with 'precoce' (early) for Group B Streptococcus, and 'T' with 'tardia' (late) for Staphylococcus, as early sepsis is associated with streptococci and late sepsis with staphylococci.

What is the primary risk factor for early neonatal sepsis?

The primary risk factor for early neonatal sepsis is maternal colonization with Group B Streptococcus, which can lead to infection during delivery.

What is the recommendation for Group B Streptococcus screening in pregnant women?

The recommendation is to perform screening for Group B Streptococcus between 35 and 37 weeks of gestation. If the test is positive, prophylactic antibiotic treatment (usually penicillin or ampicillin) is given during labor to prevent transmission to the neonate.

What should be done if the mother tests positive for Group B Streptococcus but did not receive adequate prophylaxis during labor?

If a mother tests positive but did not receive adequate prophylaxis, especially in preterm infants, blood cultures and other tests should be collected, and empirical antibiotics should be started within the first 12 to 24 hours of life.

How does chorioamnionitis influence the risk of neonatal sepsis?

Chorioamnionitis, an infection of the membranes, significantly increases the risk of early neonatal sepsis. Infants born to mothers with chorioamnionitis should be closely monitored and started on empirical antibiotics immediately after birth.

What are some of the clinical manifestations of neonatal sepsis that clinicians should watch for?

Key signs of neonatal sepsis include hypoactivity, apneas, feeding intolerance, abdominal distension, and hyperglycemia. These symptoms may indicate the need for further diagnostic testing and initiation of treatment.

How does the management of early and late neonatal sepsis differ in terms of hemodynamic stability?

Early neonatal sepsis rarely causes hemodynamic instability, while late neonatal sepsis, particularly from hospital-acquired agents, is more likely to result in hemodynamic instability and shock, especially due to Gram-negative bacteria or Staphylococcus aureus.