Neonatal Sepsis: Basics - Tiny Patient, Big Threat
Neonatal sepsis: systemic infection in first 28 days of life. High mortality/morbidity.
- Classification based on age of onset:
- Early Onset Sepsis (EOS): onset <72 hours of life.
- Late Onset Sepsis (LOS): onset ≥72 hours of life.
- EOS vs. LOS:
| Feature | EOS | LOS |
|---|---|---|
| Onset | <72 hrs | ≥72 hrs |
| Source | Maternal (Vertical) | Nosocomial/Community |
| Pathogens | GBS, E. coli, Listeria | CoNS, S. aureus, Gram-neg bacilli |
Neonatal Sepsis: Culprits & Causes - The Usual Suspects
| Onset | Timing | Common Pathogens |
|---|---|---|
| Early (EOS) | < 72 hrs | GBS, E. coli, Listeria (📌 GEL) |
| Late (LOS) | ≥ 72 hrs | CoNS, S. aureus, Gram-neg bacilli (Klebsiella, Pseudomonas), Candida |
- Prolonged Rupture of Membranes (PROM > **18** hrs)
- Maternal intrapartum fever (≥ **38**°C)
- Chorioamnionitis
- Maternal GBS colonization
- Neonatal Risk Factors:
- Prematurity (< 37 weeks gestation)
- Low Birth Weight (LBW < 2500g)
- Invasive procedures (e.g., central lines)
- Asphyxia
⭐ Group B Streptococcus (GBS) is the most common cause of Early Onset Sepsis in many regions.
Neonatal Sepsis: Spotting Trouble - Subtle Signs
Early recognition is key. Watch for these often non-specific signs:
- 📌 SUBTLE signs:
- Skin: Pallor, mottling, cool peripheries, ↑CRT >3s.
- Unusual: Lethargy, irritability, high-pitched cry, hypotonia.
- Breathing: Mild tachypnea, grunting, nasal flaring.
- Temperature: Instability (fever >38°C or hypothermia <36.5°C).
- Low Intake: Poor suck, vomiting, feeding intolerance.
- Early/Persistent Jaundice; Enlarged Abdomen (distension).
⭐ Temperature instability (fever or hypothermia) is a common but non-specific sign of neonatal sepsis.
Neonatal Sepsis: Detective Work - Finding Clues
-
Key Investigations:
- Blood Culture: Gold standard.
- Complete Blood Count (CBC): TLC <5000/mm³, ANC <1800/mm³, I/T ratio >0.2.
- C-Reactive Protein (CRP): >10 mg/L (serial values more informative).
- Lumbar Puncture (LP): If meningitis suspected or blood culture positive.
- Consider: Urine culture (late onset), CXR (respiratory signs).
-
Sepsis Screen Interpretation: ≥2 positive markers highly suggestive.
Component Positive Threshold TLC <5000/mm³ I/T Ratio >0.2 CRP >10 mg/L Micro-ESR >15 mm/1st hr
⭐ Blood culture is the gold standard for diagnosing neonatal sepsis.
Neonatal Sepsis: Battle Plan - Fighting Back
⭐ Empirical antibiotic therapy for EOS typically includes Ampicillin and an Aminoglycoside (e.g., Gentamicin).
Empirical Antibiotics (IV):
| Onset | Antibiotics | Dose Examples (adjust per guidelines) |
|---|---|---|
| EOS | Ampicillin + Gentamicin | Ampicillin 100 mg/kg IV q12h Gentamicin 4-5 mg/kg IV q24-48h |
| LOS | Vancomycin + Cefotaxime | Vancomycin 10-15 mg/kg IV q8-24h Cefotaxime 50 mg/kg IV q8-12h |
Supportive Care:
- Maintain: Thermoregulation, Glucose, Perfusion
- Support: Respiratory (O2, CPAP, MV), Cardiovascular (Fluids, Inotropes)
- Nutrition: Early enteral/parenteral
Prevention:
- Antenatal: GBS screen, Intrapartum Antibiotic Prophylaxis (IAP)
- Postnatal: Hand hygiene, Aseptic techniques, Breastfeeding
Treatment Algorithm:
High‑Yield Points - ⚡ Biggest Takeaways
- Early Onset Sepsis (EOS) occurs < 72 hours; Late Onset Sepsis (LOS) > 72 hours.
- Common EOS pathogens: Group B Streptococcus (GBS), E. coli. LOS: CoNS, Klebsiella, Candida.
- Key risk factors: Prematurity, Prolonged Rupture of Membranes (>18h), maternal chorioamnionitis.
- Clinical signs are often non-specific: lethargy, poor feeding, temperature instability, respiratory distress.
- Blood culture is the gold standard for diagnosis; sepsis screen (CRP, TLC) aids suspicion.
- Empirical antibiotics for EOS: Ampicillin plus an aminoglycoside (e.g., Gentamicin).
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