Neonatal sepsis - New Born Baby

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Slide NS- 9,10,11,12 Diagnosis 8. Cyanosis 9. H/o of convulsions Direct method NNF Teaching Aids:Newborn Care Isolation of microorganisms from blood, CSF, urine, pleural fluid or pus is diagnostic. Indirect method There are a variety of tests which are helpful for screening of neonates with sepsis. The most useful and widely used is the white blood cell count and differential count. An absolute neutrophil count of < 1800 per cmm is an indicator of infection. Neutropenia is more predictive of neonatal sepsis than neutrophilia but it may be present in maternal hypertension, birth asphyxia and periventricular hemorrhage. Immature neutrophils (Band cells + myelocytes + metamyelocytes) to total neutrophils ratio (l/T) > 0.20 means that immature neutrophils are over 20 percent of the total neutrophils because bone marrow pushes even the premature cells into circulation, to fight infection. Platelet count of less than 100,000 per cmm, toxic granules on peripheral smear and gastric aspirate smears showing more than 5 leucocytes per high power field are also useful indirect evidences of infection. The micro-ESR may be elevated with sepsis and fall of > 15 mm during first hour indicates infection. Acute phase reactants are also frequently used in predicting neonatal sepsis. The most widely used is C-reactive protein (CRP) which has a high degree of sensitivity for neonatal sepsis. The CRP can be affected by asphyxia, shock, meconium aspiration and prolonged rupture of membranes. There are a variety of other tests which can be used to predict sepsis but it may be difficult to perform them at all places and hence the clinical acumen remains crucial. A practical positive "sepsis screen" takes into account two 4
Slide NS -13,14 Supportive care or more positive tests as given below: 1. Leukopenia (TLC 15mm 1st hour) 5. CRP +ve If possible, lumbar puncture should be done in all cases of late onset (>72 hours) and symptomatic early onset sepsis because 10-15 percent of them may have associated meningitis. At a small hospital, one may only depend on the CSF cells. The implications of detecting meningitis in the setting of septicemia include: the need for using antibiotics with a high CSF penetration and provision of antibiotic treatment for at least 3 weeks, administered parenterally throughout. Treatment No investigation is required as a prerequisite to start treatment in a clinically obvious case. Early treatment is crucial. Institution of prompt treatment is essential for ensuring optimum outcome of neonates with sepsis who often reach the health care facilities late and in a critical condition. Supportive care and antibiotics are two equally important components of the treatment. It should be realized that antibiotics take at least 12 to 24 hours to show any effect and it is the supportive care that makes the difference between life and death early in the hospital course. The purpose of supportive care is to normalize the temperature, stabilize the cardiopulmonary status, correct hypoglycemia and prevent bleeding tendency (Table-II). The septic neonate should be nursed in a thermo neutral environment. If hypothermic, the temperature should be raised using a heat source. An intravenous line should be established. If perfusion is poor as indicated by a capillary refill time of more than 3 seconds, normal saline bolus should be infused immediately. A dextrose bolus will help correct hypoglycemia which is often present in septic infants. Vitamin K should be given to prevent bleeding. Oxygen should be provided if the 5
Page 1 and 2: Slide NS -1 Definition Slide NS -2
Page 3: NNF Teaching Aids:Newborn Care TABL
Page 7 and 8: NNF Teaching Aids:Newborn Care TABL
Page 9 and 10: Slide NS-19,20 Hand washing Slide N

Neonatal sepsis - New Born Baby

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