INTRODUCTION

Newborn infants are at much higher risk for developing sepsis than children and
adults because of their immature immune systemespecially premature infants,
where 1 out of every 250 will be diagnosed with sepsis. Sepsis is one of the major
leading causes of death in the first few months of a newborns life. Infections can
contribute up to 13-15% of all deaths during the neonatal period with the mortality
rate reaching as high as 50% for infants who are not treated timely.Infections are a
major contributor to newborn deaths in developing countries. Majority of these deaths
occur at home without coming to medical attention. The Millennium Development
Goal for child survival cannot be achieved without substantial reductions in infectionspecific neonatal mortality. We describe the burden of neonatal infections in
developing countries and discuss the need for community-based management
approaches to improve survival from neonatal infections in these countries.
DEFINITION
Neonatatal infection is the infections that occurred soon after birth due to some
maternal infections or bacterias colonised from insturuments.
INCIDENCES
The incidence of serious acute infections in neonates is around 2/1,000 live births but
the figure rises to 8-9/1,000 in small babies weighing just 1,000 to 2,000 grams and
26/1,000 in those of less than 1,000 grams. GBS is the most frequent cause of severe
early-onset neonatal infection in neonates and occurs in 0.5/1,000 UK births.
Of early-onset neonatal sepsis, 85% presents in the first 24 hours, 5% between 24 and
48 hours, and the remaining 10% over the subsequent 4 days. Early-onset infections
include GBS, Escherichia. coli, Haemophilusinfluenzae, and Listeria monocytogenes
and are most likely to have been acquired transplacentally, by ascending or
intrapartum infection.
RISK FACTORS OF NEONATAL INFECTION

Rupture
Maternal intra part of fever
Low birth weight infant
Chorioamniontis
Mother with beta haemolytic streptococccal infection
Repeated vagina examination in labour

MODES OF INFECTION
Antenatal
a) Transplacental : Maternal infection that can affect through placental root.
They are rubella,cytomegalovirus,herpesvirus,HIV,chickenpox and hep B. other
infections are syphilis,toxomoplasmosis and tb
b) Amnionits: aminonitis following premature rapture of membrane can be
affected the baby following aspiration or injection of infected amniotic fluid.
Intranatal
The following are the modes of intranatal to the babies
a) Aspiration of infected liqor or meconium following early rupture of membrane
or repeated internal examination this may lead to neonanatalsepsis.
b) While the fetus is passing through the infected vagina
c) Improper asepsis while caring the umblicalcord.
Postnatal
Transmission due to human contact :
a) infected mother relatives or staffs of the nursery
b) Cross infection from a infected baby in the nursery.
c) Infection through feeding, bathing, clothing or airborne
COMMON SITES OF INFECTION
Trivial but may not be serious

Eyes-ophthalmia neonatorum
Skin infections
Umbilicus sepsis (omphalitis)
Oral thrush

Severe systemic

Respiratory tract
Septicaemia
Meningitis
Intra abdominal infection

OPHTHALMIA NEONATORUM

DEFINITION
Ophthalmia neonatorum is defined as inflammation of the conjunctivitis during first
month of life
CAUSES
The cause of the conjunctivitis may be an irritation in the eye or a blocked tear
duct.
In some cases the irritation may be from the antibiotic given after delivery.
The common causative organism are Chlamydia trachomatis,other bacterial
causes like gonococcus,styphylococcus
chemicals like silver nitrate
viral:herpes simplex
MODE OF INFECTION
Infection occurs mostly during delivery by contaminated vaginal discharge. It is
more likely in face or breech delivery. During neonatal period, there may be direct
contamination from other sites of infection or by chemical.
CLINICAL FEATURES
The most common symptoms are redness and swelling of the conjunctiva in the
newborn.
Drainage and discharge from the eye; it may be watery or thick and pus-like
Swollen eyelids
Cornea may be involved in severe cases.
DIAGNOSIS
If your babys pediatrician suspects ophthalmianeonatorum, an eye
examination will be done. The doctor will look at your babys eyes to check for
anything that may be irritating the eye, and to see if any damage has occurred.
The doctor may also want to take a sample / smear of any discharge to
determine what type of bacteria or virus is causing the infection.
Culture and sensitivity
Scraping material from kwier conjunctiva for Giemsa staining and also culture
in suspected ehlamydial infection;
Culture in special viral media for suspected herpes simplex infection.

PROGNOSIS

It is favorable to most cases except in neglected cases with rare gonococcal

infection. Fortunately, effective methods of prophylaxis and treatment have almost
eliminated the risk of blindness.
PREVENTION
Any suspicious vaginal discharge during the antenatal period should be treated and
the most meticulous obstetric asepsis is maintained at birth. The newborn baby's
closed lids should be thoroughly cleansed and dried.
TREATMENT
Prophylaxis: 1 percent silver nitrate solution (1-2 drops to each eye), 0.5 percent
erythromycin ophthalmic ointment, 25 percent povidone iodine solution (1 drop each
eye) is administered within 1 hour of birth and is continued for few days.
The treatment of ophthalmianeonatorum depends on the cause:
1) Blocked Tear Duct
In cases of ophthalmianeonatorum that are due to a blocked tear duct, the doctor may
recommend warm compresses and gentle massage to the area to help unclog the duct.
2) Irritation
Ophthalmianeonatorum due to irritation usually improves on its own in a few days. In
some cases, the irritation may be from the antibiotic given after delivery. Silver
nitrate, which was often used in the past to prevent eye infection, can cause irritation
in the babys eye. Many hospitals now use other types of antibiotics to avoid this
irritation.
3) Bacteria
Infants that have an eye infection due to bacteria are given antibiotics.Antibiotic
ointment will be started right away.Antibiotics are also given orally or as an injection
if caused by an STD.
Drugs used in infections are
a)GonococcalInfant is isolated during the first 24 hours of treatment. Eyes are
irrigated with sterile isotonic saline every 1-2 hours until clear. In severe and
culture positive cases systemic ceftriaxone 50 mg/kg or cefotaxime 50
mg/kg/q 12 h is given IM/IV. Single dose in infant without dissemination or
for 7 days when there is dissemination, is usually given.

b)ChlamydiaErythromycin suspension 40 mg/kg daily orally divided into 4

doses for 14 days is given to prevent systemic infection. Topical treatment
alone is ineffective.
c)Herpes simplexThe infant is isolated. Systemic therapy with acyclovir 20
mg/kg every 8 hours for 2 weeks is given IV. Topical use of 0.1%
iododeoxyuridine ointment 5 times a day for 10 days is used.
SKIN INFECTION
Skin infection is predominantly due to staphylococcus aureus. Unhygienic
environment, cross infection or carriers are the source of infection
IN MILD FORM
Superficial pustules, single ore scattered are the formed on the face axilla or scalp
Pemphigus neonatorum: it is the serious form of skin infection in the new born .it
may become epidemic and may cause septic caemia . superficial blisters appear on the
part of skin become pustules and then burst.
CURATIVE
The baby is place in isolation the blisters are pricked by sterile needle and after
removal of dead skin the area is to be smeared with antibiotic ointment(1%
gentianviolet in spirit).Systematic administration of erythromycin 25 mg per kg or
cloxacillin 50 mg per kg per day in 3 to 5 divided doses.
PREVENTION
Baby bath is best avoided in hospital delivery the infected babies are to be kept in
separated nursery. The carriers or sources of infection are to be sought for an
appropriate measures to be taken.
UMBILICAL SEPSIS (OMPHALITIS)
DEFINITION
Omphalitis is the medical term for infection of the umbilical cord stump in the
neonatal newborn period. The causative organisms are staphylococcus, e coli or
pyogenic organism.
SIGNS AND SYMPTOMS
infection (cellulitis) around the umbilical stump (redness, warmth, swelling,
pain)

 pus from the umbilical stump,

fever
fast heart rate (tachycardia)
Omphalitis can quickly progress to sepsis and presents a potentially life-threatening
infection.
SPREAD OF INFECTION
1. Periumbilical cellulitis with suppuration;
2. Thrombophlebitis of the umbilical vein with extension of the infection to the
liver producing hepatitis or pyemic liver abscess;
3. Peritonitis;
4. Necrotizing fascitis.
DIAGNOSIS
Diagnosis is usually made by the clinical appearance of the umbilical cord stump and
the findings on history and physical examination. There may be some confusion,
however, if a well-appearing neonate simply has some redness around the umbilical
stump. In fact, a mild degree is common, as is some bleeding at the stump site with
detachment of the umbilical cord. If needed culture and sensitivity test is done.
PREVENTION
Antiseptic and aseptic precaution should be taken right from the time of cutting the
cord to the time of complete epithelization of the area after falling of the cord.
TREATMENT
Complete septic work up (CBC, blood and umbilical swab culture) is done.
Antibiotic therapy with nafcillin and gentamicin or oxacillin or
piperacillin/tazobactum may be used depending upon the severity of infection.
The wound is dressed like any surgical wound with spirit and antiseptic
powder.
TETANUS NEONATORUM:
It is rare nowadays but may cause concern in the tropical countries. The infection is
caused by Cl. tetani and the portal of entry is through the umbilical cord. The
features are evident within 5-15 days after birth.

THE STRIKING FEATURES

Inability to suck associated with marked trismus followed by rigidity of the
body with opisthotonus,
pyrexia
convulsions.
PREVENTION
Includes immunization of the mother during pregnancy with tetanus toxoid. Babies
born in unhygienic conditions without previous immunization of the mother, should
be given 1500 1U of antitetanus serum intramuscularly soon after birth.
CURATIVE TREATMENT
The baby should be isolated in the Infectious Disease Hospital;
Tetanus immune globulin (human) 6000 IC is given intramuscularly
Anti tetanus serum (ATS) should be started immediately in doses of 50,000100,000 units intramuscularly or intravenously. The same dose may have to be
repeated after 12 hours;
Antibiotics' 1.-,art-cularly penicillin should be given in heavy doses;
Sedation should be ensured by intramuscular administration of either (a)
Chlorpromazine 5-10 mg/kg per day or (b) Phenobarbitone 15 mg/kg per day in
divided doses. Both may be combined so as to be more effective;
Endotracheal intubation and ventilation may be needed;
Nutrition is to be maintained by intragastric feeding. Prognosis: Mortality is up
to 60-80%.
NECROTIZING ENTER COLITIS
Necrotizing enterocolitis (NEC) is a medical condition primarily seen in premature
infants, where portions of the bowel undergo necrosis (tissue death). It is the second
most common cause of morbidity in premature infants and requires intensive care over
an extended period.
CAUSES

Premature infants
Perinatal asphysis
Polycythemia
Umbilical cord catheter related thrombo embolism
Septecimia due to ecoli,klebcsiella

RISK FACTORS

Premature infants
Perinatal asphyxia
Hypotension
Polycythemia
U.mbilical cord catheter related thromboembolism;
Septicemia due to E coil, Klebsiella, Pseudomonas
Exchange transfusion.

PATHOPHYSIOLOGY
There is ischemic and/or toxic damage to the mucous membrane of the gut commonly
in the ileocecal region. It is associated with bacterial proliferation and gas formation.
Gradually there is ischemic necrosis of the muscular wall of the gut, ultimately
leading to perforation and peritonitis.
SIGNS AND SYMPTOMS
The condition is typically seen in premature infants, and the timing of its onset is
generally inversely proportional to the gestational age of the baby at birth, i.e. the
earlier a baby is born, the later signs of NEC are typically seen. Initial symptoms
include feeding intolerance, increased gastric residuals, abdominal distension and
bloody stools. Symptoms may progress rapidly to abdominal discoloration with
intestinal perforation and peritonitis and systemic hypotension requiring intensive
medical support.
clinical features are divided into 3 stages:
Stage 1 Apnea, bradycardia, lethargy, abdominal distension and vomiting.
Stage 2 Pneumatosisintestinalis and the above features.
Stage 3 Low blood pressure, bradycardia, acidosis, disseminated intravascular
coagulation (DIC) and anuria.
Systemic signs: Respiratory distress, lethargy, feeding intolerance, hypertension,
acidosis, oliguria and bleeding diathesis. Abdominal signs are: Abdominal distension,
tenderness, bloody stools, vomiting.
DIAGNOSIS
The diagnosis is usually suspected clinically but often requires the aid of diagnostic
imaging modalities. Radiographic signs of NEC include dilated bowel loops, paucity
of gas, a "fixed loop" (unaltered gas-filled loop of bowel), pneumatosisintestinalis,
portal venous gas, and pneumoperitoneum (extraluminal or "free air" outside the
bowel within the abdomen). The pathognomonic finding on plain films is

pneumatosisintestinalis. More recently ultrasonography has proven to be useful as it

may detect signs and complications of NEC before they are evident on radiographs.
Diagnosis is ultimately made in 510% of very low-birth-weight infants
(<1,500g).However, it is not known whether some underlying pathology contributes to
premature birth and low birth weight.
TREATMENT
Respiratory system:
Supplemental 02 and mechanical ventilation may be needed
Support to the cardiovascular system
Circulatory volume, blood pressure, arterial blood gas, tissue perfusion is
maintained.
Nutrition Discontinuation of oral feeding and to start nasogastric suction

Total

parenteral nutrition
Laboratory monitoring for arterial blood gas, serum electrolytes, blood glucose,
platelet count, acid base balance and septic work up are done
Antibiotics Ampicillin, gentamicin or cefotaxime and metronidazole; Bowel
resection in the case of perforation.
PROGNOSIS
Mortality is up to 40 percent when associated with perforation.Typical recovery from
NEC if medical, non-surgical treatment succeeds, includes 1014 days or more
without oral intake and then demonstrated ability to resume feedings and gain weight.
Recovery from NEC alone may be compromised by co-morbid conditions that
frequently accompany prematurity. Longterm complications of medical NEC include
bowel obstruction and anemia.
Despite a significant mortality risk, long-term prognosis for infants undergoing NEC
surgery is improving, with survival rates of 7080%. "Surgical NEC" survivors are atrisk for complications including short bowel syndrome, and neurodevelopmental
disability

ORAL THRUSH (MUCOCUTANEOUS CANDIDIASIS)

DEFINITION
Infection of the bucal mucosal membrane and the tongue by the fungus.
Oral thrush is a condition in which the fungus Candida albicans accumulates on the
lining of mouth or infection of buccal mucous membrane.Oral thrush causes creamy
white lesions, usually on tongue or inner cheeks. The lesions can be painful and may
bleed slightly when you scrape them. Sometimes oral thrush may spread to the roof of
mouth, gums, tonsils or the back of throat.
CAUSES
Contamination by the organism occurs from the feeding bottles, teats, nurses hand
mothers nipple and infected vagina.
The fungus grows on the mucous membrane and produce milky white patches, which
cannot be easily wiped of with goes. The fungal infection may rarely spread down to
GI or special respiratory track.It usually appears in the last first week or during the
second week
SYMPTOMS
The infant refuses to take feed ,crying ,GI upset
TREATMENT
Local applications of 1% aqueous solution of gentian violet on the oral
mucous membrane twice daily after feed for 2-3 days is quite effective but not
used now due to many side effects.
Nystatin oral suspension (100,000 U/Ml) is applied to each side of the mouth 4
times a day for about 2-3 weeks.
Systemic fluconazole is highly effective in chronic mucocutaneous candidiasis
Infants with chronic thrush refractory to usual treatment should be investigated
for immune deficiency.
mothers with breast ductal candidiasis, concurrent treatment of both the
mother and infant is done to eliminate cross infection.
Diaper candidal dermatitis is treated with topical 2% nystatin ointment,2%
miconazole ointment or 1% clortrimazole cream.
PROGNOSIS
If effectively treated cure is very prompt but if neglected cases it may spread to
respiratory elementary track also.

NEONATAL SEPSIS
INTRODUCTION
Neonatal sepsis is a bacterial infection in the blood. It is found in infants during the
first month of life. This may become a serious condition. If you suspect your infant
has this condition, contact your doctor right away.
Early onset sepsis develops in the first 2-3 days after birth. Late onset sepsis develops
within 3-7 days after birth.
CAUSES
Neonatal sepsis is caused by bacteria. The infant may come in contact with
bacteria during pregnancy, birth, or from the environment after birth.
Early onset sepsis is caused by an infection from the mother. It may pass to the
infant from the placenta or birth canal during birth. Antibiotics may be given to
high risk mothers, during labor. They have been able to prevent early onset
bacterial sepsis in some infants.
Late onset sepsis is caused by bacteria from the care giving environment.
RISK FACTORS
The following factors increase your infants chance of developing neonatal sepsis:
Premature birthmore than three weeks before due date
Early labormore than three weeks before your due date
Infant is in distress before being born
Infant has a very low birth weight
Infant has a bowel movement before being born and fetal stool is in the uterus
Amniotic fluid surrounding the infant has a bad smell or the infant has a bad
smell right after being born
Male babies have a greater risk for neonatal sepsis than female babies
Pregnancy conditions or mother's health issues that increase your infant's chance of
sepsis include:

Labor complications resulting in traumatic or premature delivery

Water that broke more than 18 hours before giving birth
Fever or other infections while you are in labor
Need for a catheter for a long time while you are pregnant
Presence of group B streptococcal bacteria in vaginal or rectal areas
Many courses of prenatal steroids
Prolonged internal monitoring during labor and delivery

SYMPTOMS

In most cases of early onset sepsis, symptoms are present within 24 hours of birth.
In almost all cases, symptoms will be present within 48 hours of birth. If your infant
has any one of these symptoms, especially in first week, contact your doctor

Fever or frequent changes in temperature

Breathing rapidly, difficulty breathing, or periods of no breathing (apnea)
Lethargy (abnormal sleepiness)
Poor feeding from breast or bottle
Decreased or absent urination
Bloated abdomen
Vomiting yellowish material
Diarrhoea
Extreme redness around the belly button
Skin rashes
Difficulty waking your infant or unusual sleepiness
Jaundiced or overly pale skin
Abnormally slow or fast heartbeat
Bruising or bleeding
Seizures
Cool, clammy skin
It is important for your doctor to evaluate any fever in your infant.
DIAGNOSIS
Your doctor will ask about your infants symptoms and medical history. A physical
exam will be done.
Tests may include the following:
Blood tests such as complete blood count
Cultures of:
o Blood
o Urine
o Cerebrospinal fluidthrough spinal tap
o Skin lesions
X-rays of the chest or abdomen
TREATMENT
Treatment depends on how severe the condition is. If sepsis is suspected, your infant
will be hospitalized while you wait for test results.
Treatment may last 2-21 days. A well-appearing infant may be monitored
without antibiotics. Your infant will be sent home when tests show there are no
bacteria. Sepsis that is confirmed with a culture test is treated for 7-21 days. Treatment
will depend on the location of the infection. Treatment options include antibiotics and
support care like oxygen or IV fluids.

Antibiotics
Antibiotic medicine may have to be given directly into the vein (IV).
Intravenous Fluids
IV fluids will help support your infant until the infection clears. It may include fluids,
glucose, and electrolytes.
Oxygen
Your infant may need oxygen therapy. In more severe cases, a ventilator may be used
to support breathing.
Prevention
To reduce your infants chance of getting neonatal sepsis, your doctor may take the
following steps:
Antibiotics can control dangerous bacteria in the mother. It will prevent the spread
of bacteria during pregnancy or birth to the infant. Your doctor may recommend
antibiotics if:
o The birth mother has previously given birth to an infant with neonatal
sepsis.
o You have had a positive bacterial infection test before your due date.
Breastfeeding may also help prevent sepsis in some infants.
Follow steps to prevent premature labor or birth. This can include proper prenatal
care, avoiding drugs and alcohol, and eating a healthy balanced diet.
HIV INFECTION
Main route of vertical transmission is at birth, but also transplanted and via breast
feeding.
Factors which increase transmission
-

Advanced maternal transmission

High plasma viral load
Primary infection during pregnancy or breast feeding
Concomitant sexually transmitted infections
Rapture of the membranes longer than 4 hours
Vaginal delivery
Blood exposure/instrumental delivery

Interventions that reduce transmission

-

Anti retroviral therapy to mother antenatally and postpartum to the infant

Treatment of other maternal sexually transmitted infections
Elective cesarean section with avoidance of labor and contact with the birth
canal
Formula feeding instead of breast feeding

Diagnosis
Confirmation that the infant is infected relies on three negative tests for the viral
antigen and or genome antibody tests cannot be used as maternal antibody is detected
until 18 months.
Management
Infants should receive cotrimoxazole as prophylanis against pneumocystis pneumonia
from 4 weeks of age until negative HIV results are available.
SYPHILIS
Causative agent
Treponemapallidum
Time of transmission
Transplacental and hematogenous any time during pregnancy.
Maternal infection:
Fetus is affected if untreated maternal infection occur less than 1 to 2 before gestation.
Teratogenic effects:
Some effects are delayed eg: eyes, saddle nose due to bone destruction.
Laboratory diagnosis
Dark field examination for spirochetes especially of cerebrospinal fluid .
Nursing intervention and management
1V or 1M pencillin during neonatal period after the neonatal period erythromycin and
tetracycline may be used for children allergee to pencillin.
-

Tetracycline should not be given to children under age 8 yrs because it may
stain deciduous or permanent teeth nurses wear disposable gloves to prevent
contamination pinpricks with contaminated safety pins. Clean infants nose to
avoid encoriation of skin and to aid in feeding.

Prevention
Serologic blood test before marriage . Routine scrologic testing of pregnant women in
1st and 3rdtrimesters .
Treatment of pregnant women before 18UK of pregnancy prevents infection.

NURSING MANAGEMENT FOR NEONATAL INFECTIONS

Nursing Diagnoses and interventions
Hyperthermia related to inflammatory process/ hypermetabolic state as evidenced by
an increase in body temperature, warm skin and tachycardia
1.

Monitor neonates condition.

2.

Monitor Vital signs

3.

Provide TSB

4.

5.

Ensure that all equipment used for infant is sterile, scrupulously clean. Do not
share equipment with other infants
Administer Anti-pyretics as ordered

Fluid volume deficit related to failure of regulatory mechanism

1.

Monitor and record vital signs

2.

Note for the causative factors that contribute to fluid volume deficit

3.

Provide TSB if patient has fever

4.

Provide oral care by moistening lips & skin care by providing daily bath

5.

Administer IV fluid replacement as ordered

6.

Administer antipyretic drugs if patient has fever as ordered

Ineffective tissue perfusion related to impaired transport of oxygen across alveolar and
on capillary membrane
1.

Monitor neonates condition

2.

Monitor Vital signs

3.

Note quality and strength of peripheral pulses

4.

Assess respiratory rate, depth, and quality

5.

Assess skin for changes in color, temperature and moisture

6.

Elevate Head of Bead

7.

Elevate affected extremities with edema once in a while

8.

Provide a quiet, restful atmosphere

9.

Administer oxygen as ordered

Interrupted breastfeeding related to neonates present illness as evidenced by

separation of mother to infant
1.

Assess mothers perception and knowledge about breastfeeding and extent of

instruction that has been given.

2.

Give emotional support to mother and accept decision regarding cessation/

continuation of breast feeding.

3.

Demonstrate use of manual piston-type breast pump.

4.

Review techniques for storage/use of expressed breast milk

5.

Determine if a routine visiting schedule or advance warning can be provided

6.

Provide privacy, calm surroundings when mother breast feeds.

7.

Recommend for infant sucking on a regular basis

8.

Encourage mother to obtain adequate rest, maintain fluid and nutritional intake,
and schedule breast pumping every 3 hours while awake

Risk for Impaired parent/ neonates Attachment related to neonates physical illness and
hospitalization
1.

Interview parents, noting their perception of situational and individual concerns

2.

Educate parents regarding child growth and development, addressing parental

perceptions

3.

Involve parents in activities with the newborn that they can accomplish
successfully

4.

Recognize and provide positive feedback for nurturing and protective

parenting behaviours

SUMMARY
Despite the major advances in neonatal medicine, many infants still develop lifethreatening infections during the first month of life. Identifying and caring for an
infant with a possible infection starts with a skilled nurse who is proficient in
performing neonatal assessments. The assessment begins with a nurses innate
knowledge of the many different risk factors for newborn infection. The nurse needs
to be observant for any sign that may indicate sepsis. It cannot be overemphasized that
prompt recognition, early diagnosis, and immediate treatment of sepsis can
dramatically improve the infants outcome and limit any potential disability. Once
sepsis has been identified, treatment must be initiated promptly, and the infant
reassessed for their response to the therapy. Hours can make the difference of an infant
surviving the infection, or succumbing to its systemic devastation. Because of the
nonspecific manifestations of impending sepsis, any changes in the physical and/or
behavioral state of an infant should raise the suspicion of sepsis. Above all else,
nursing assessment and interventions are the most important tool in the prevention,
prompt recognition, and effective management of newborn infections.
CONCLUSION
So far discussed about neonatal infections. Some infections are more serious in
pregnancy than in the non-pregnant state because of the potential for vertical
transmission. Infection can pass vertically from mother to fetus/neonate in several
ways.Perinatal period - from 24 weeks of gestation to 7 completed days following the

time of birth.Neonatal period - from birth to 27 completed days, sometimes

subdivided into early neonatal (birth to 6 completed days) and late neonatal (day 7 to
day 27 completed days).

BIBILIOGRAPHY
Text books
D C Dutta. Text book of obstetrics.6th edition. new central book publishers.
page number.488-491
Dorothy.R.Marlow,Barbar A Redding.The book of paediatric nursing. 6th
edition. saunders Elsevier publishers. page no:422-426
Op ghai. essential paediatrics. 6th edition. CBS publishers. page numbr: 161163
Annamma Jacob.A comprehensive textbook on midwifery and gynaecological
nursing. 1st edition. 2005. Jaypee publishers. Page no 543
Lowdermilk,pery,cashion. Maternity nursing. 8th edition. Mosby Publishers.
Page no-775.
Lynna Y.Littileton. Maternity nursing care. 1st edition. Delmar lerning
pubishers. Page no 895.
Fraser Cooper. Myles text book for midwives. 14th edition. Churchill
Livinstone Publishers. Page no 878-885.
Journals
The Indian journal of paediatrics Dr .Varma I C, VOLUME 79/NUMBR
2/MARCH 2012 PAGE NUMBER 58-61
The Indian journal of paediatrics Dr .Varma I C, VOLUME
79/NUMBR12/MARCH 2010 PAGE NUMBER 97-99
Web sites
http://www.patient.co.uk/doctor/congenital-perinatal-and-neonatal-infections
http://www.orlandohealth.com/pdf%20folder/neonatal%20sepsis.