E.A.C.

SCHOOL OF MEDICINE
PEDIATRICS II NEONATAL SEPSIS
DR. SHARLENE G. SANTIAGO-SENG, M.D.

DEFINITION & INCIDENCE Gram-negative enterics (esp. E.

coli)
Clinical syndrome of systemic illness
accompanied by bacteremia occurring in the Listeria monocytogenes,
first month of life Staphylococcus, other
streptococci (entercocci),
Incidence anaerobes, H. flu

1-8/1000 live births 2. Nosocomial Sepsis

13-27/1000 live births for infants < Varies by nursery

1500g
Staphylococcus epidermidis,
Mortality rate is 13-25% Pseudomonas, Klebsiella,
Serratia, Proteus, and yeast are
Higher rates in premature infants and those most common
with early fulminant disease
RISK FACTORS

Prematurity and low birth weight

EARLY VS. LATE ONSET SEPSIS
Premature and prolonged rupture of
membranes

Maternal peripartum fever

Amniotic fluid problems (i.e. mec, chorio)

Resuscitation at birth, fetal distress

Multiple gestation

Invasive procedures

Galactosemia
NOSOCOMIAL SEPSIS
Other factors: sex, race, variations in
Occurs in high-risk newborns immune function, hand washing in the NICU

Pathogenesis is related to CLINICAL PRESENTATION

the underlying illness of the infant Clinical signs and symptoms are nonspecific

the flora in the NICU environment Differential diagnosis

invasive monitoring RDS

Breaks in the barrier function of the skin and Metabolic disease

intestine allow for opportunistic infection
Hematologic disease
CAUSATIVE ORGANISMS
CNS disease
1. Primary Sepsis
Cardiac disease
Group B streptococcus
A.G. 1
 Other infectious processes (i.e. TORCH) ADJUNCTIVE LAB TESTS

Temperature irregularity (high or low) 1. White blood cell count and differential

Change in behavior Neutropenia can be an ominous

sign
Lethargy, irritability, changes in
tone I:T ratio > 0.2 is of good
predictive value
Skin changes
Serial values can establish a
Poor perfusion, mottling, trend
cyanosis, pallor, petechiae,
rashes, jaundice 2. Platelet count

Feeding problems Late sign and very nonspecific

Intolerance, vomiting, diarrhea, 3. Acute phase reactants

abdominal distension
CRP rises early, monitor serial
Cardiopulmonary values

Tachypnea, grunting, flaring, ESR rises late

retractions, apnea, tachycardia,
hypotension 4. Other tests: bilirubin, glucose, sodium

Metabolic RADIOLOGY

Hypo or hyperglycemia, 1. CXR

metabolic acidosis
Obtain in infants with respiratory
DIAGNOSIS symptoms

Cultures: Difficult to distinguish GBS or

Listeria pneumonia from
1. Blood uncomplicated RDS

Confirms sepsis 2. Renal ultrasound and/or VCUG

94% grow by 48 hours infants with accompanying UTI

of age
MATERNAL STUDIES
2. Urine
Examination of the placenta and fetal
Dont need in infants membranes for evidence of chorioamnionitis
<24 hours old because
UTIs are exceedingly MANAGEMENT
rare in this age group
Antibiotics
3. CSF
Primary sepsis: ampicillin and
Controversial gentamicin

May be useful in Nosocomial sepsis:

clinically ill newborns or vancomycin and gentamicin
those with positive or cefotaxime
blood cultures
Change based on culture
sensitivities

A.G. 2
 Dont forget to check levels

SUPPORTIVE THERAPY

1. Respiratory

Oxygen and ventilation as

necessary

2. Cardiovascular

Support blood pressure with volume

expanders and/or pressors

3. Hematologic

Treat DIC with FFP and/or cryo

4. CNS

Treat seizures with

phenobarbital

Watch for signs of SIADH

(decreased UOP, hyponatremia)
and treat with fluid restriction

5. Metabolic

Treat
hypoglycemia/hyperglycemia
and metabolic acidosis

A.G. 3