Sepsis Neonatus

Summary

This video covers essential information on neonatal sepsis, focusing on its classification into early onset sepsis (EOS) and late onset sepsis (LOS). It explains the causes, risk factors, clinical manifestations, and diagnostic procedures for detecting sepsis in neonates. The video also delves into the appropriate treatments, including antibiotic regimens like ampicillin and gentamicin for EOS, and fomisins and aminoglycosides for LOS. It highlights the importance of early recognition and proper antibiotic dosage to avoid complications such as ototoxicity and nephrotoxicity. Key management strategies for supporting neonates with sepsis are also discussed.

Takeaways

• 😀 Neonatal sepsis is a syndrome caused by bloodstream infections in infants under 28 days old, with a mortality rate of 13% to 25%.
• 😀 Early Onset Sepsis (EOS) occurs within 72 hours of birth and is commonly caused by pathogens from the birth canal, such as Group B Streptococcus (GBS) and E. coli.
• 😀 Late Onset Sepsis (LOS) occurs after 72 hours of birth and is often nosocomial, typically due to invasive procedures or prematurity.
• 😀 Risk factors for EOS include chorioamnionitis, prolonged rupture of membranes, and prematurity.
• 😀 LOS is often caused by Staphylococcus epidermidis, and the incidence has remained relatively stable over time.
• 😀 Early signs of neonatal sepsis include irritability, lethargy, and poor feeding, and symptoms can worsen quickly.
• 😀 Key diagnostic indicators for neonatal sepsis include leukopenia (white blood cell count <5,000), abnormal CRP levels, and positive blood cultures.
• 😀 Radiological exams can help diagnose conditions like pneumonia, while blood gas analysis may indicate metabolic acidosis or hypoxia.
• 😀 Treatment involves initial stabilization (ABC) followed by empirical antibiotics: ampicillin + gentamicin for EOS, and a combination of vancomycin + gentamicin for LOS.
• 😀 Precise dosing of aminoglycosides, like gentamicin, is critical due to the risks of ototoxicity and nephrotoxicity, especially in neonates.
• 😀 Gentamicin dosing differs based on infant weight and age, with premature infants receiving lower doses compared to full-term infants.

Q & A

What is neonatal sepsis?

Neonatal sepsis is a syndrome caused by an infection in the bloodstream of infants less than 28 days old, leading to a range of clinical symptoms and a high mortality rate of 13% to 25%.

How is neonatal sepsis classified?

Neonatal sepsis is classified into two main types: Early-Onset Sepsis (EOS), which occurs within 72 hours of birth, and Late-Onset Sepsis (LOS), which develops after 72 hours.

What are the main pathogens responsible for Early-Onset Sepsis (EOS)?

The main pathogens responsible for EOS include Group B Streptococcus (GBS), Escherichia coli, coagulase-negative staphylococci, Haemophilus influenza, and Listeria monocytogenes.

What are the primary risk factors for Early-Onset Sepsis (EOS)?

Risk factors for EOS include maternal chorioamnionitis, prolonged rupture of membranes, and premature birth.

How does Late-Onset Sepsis (LOS) differ from Early-Onset Sepsis (EOS)?

LOS occurs after 72 hours of birth and is typically caused by nosocomial infections, often linked to invasive procedures or infections transmitted by healthcare providers, while EOS is primarily due to pathogens transmitted through the birth canal.

What are the common pathogens responsible for Late-Onset Sepsis (LOS)?

The main pathogen responsible for LOS is **Staphylococcus epidermidis**, although other bacteria may also play a role.

What clinical signs should raise suspicion of neonatal sepsis?

Clinical signs include irritability, lethargy, poor feeding, abnormal temperature (often hypothermia), tachycardia, respiratory distress, jaundice, and abdominal distension, among others.

What is the role of leukopenia in diagnosing neonatal sepsis?

Leukopenia (a white blood cell count less than 5000 cells/μL) is considered a better predictor of sepsis in neonates. It is one of the key diagnostic indicators when assessing for neonatal sepsis.

How is the diagnosis of neonatal sepsis confirmed?

Diagnosis is confirmed through a combination of clinical signs and laboratory tests, such as blood cultures, urine cultures, cerebrospinal fluid (CSF) cultures, and complete blood count (CBC) to check for abnormalities like leukopenia or leukocytosis.

What is the initial management approach for a neonate suspected of sepsis?

The initial approach involves stabilizing the neonate by addressing the airway, breathing, and circulation (ABC), followed by the administration of empiric antibiotics while awaiting culture results.

What antibiotics are used in the treatment of neonatal sepsis?

For EOS, a combination of ampicillin and gentamicin is typically used, while for LOS, a combination of cefotaxime and gentamicin, or ampicillin and cefotaxime, is often recommended.

What are the risks associated with aminoglycosides like gentamicin in neonates?

Aminoglycosides like gentamicin can be ototoxic and nephrotoxic, which is why careful dosing is essential to avoid damage to hearing and kidneys.

Why is ceftriaxone avoided in neonates with sepsis?

Ceftriaxone is avoided in neonates because it can cause hyperbilirubinemia, which can be dangerous for newborns.

What additional supportive care may be required in neonates with sepsis?

Supportive care may include managing seizures, correcting electrolyte imbalances, providing respiratory support, and addressing any other complications like hypoglycemia or hypoxia.

How is the dosing of gentamicin adjusted in neonates based on their age and weight?

For neonates less than 7 days old and weighing less than 2 kg, gentamicin is dosed at 3 mg/kg once daily. For those over 7 days old, the dosage is adjusted to 7.5 mg/kg every 12 hours.