logging in or signing up Neonatal Sepsis vittal Download Post to : URL : Related Presentations : Let's Connect Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 1577 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: April 28, 2013 This Presentation is Public Favorites: 3 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript PowerPoint Presentation: C.S.N.Vittal Vijayawada Neonatal SepsisPowerPoint Presentation: Bacterial Sepsis in Neonate Clinical syndrome of infection with bacterimia in first month of life. May get predominantly localized to lung (Pneumonia) May be localized to meninges (meningitis) Definition :PowerPoint Presentation: Bacterial Sepsis in Neonate 24 / 1000 live births Incidence : Single most important cause of neonatal deaths in the community (>50%)PowerPoint Presentation: Bacterial Sepsis in Neonate Patterns Early Onset Late Onset Within 72 hrs of birth Complicated pregnancy + Maternal Genital tract Fulminant course Pneumonia 5-50 % mortality Symptoms beyond 72 hrs of birth Complicated pregnancy + Maternal Genital tract / Environmental Slower progression Meningitis 2-6 % mortalityPowerPoint Presentation: Neonatal Sepsis Major Risk Factors Ruptured membranes > 24 hrs. Maternal Fever (100.4 o F(38 o C) Chorionamnionitis Sustained fetal heart rate >160/min Multiple obstetric procedures Minor Risk Factors Ruptured membranes > 12 hrs. Foul smelling liquor Maternal Fever > 99.5 o F (37.5 o C) Low APGAR < 5 at 1 min, < 7 at 5 min Prematurity Multiple gestation Presence of 1 major or 2 minor risk factors -> High Risk of SepsisNNF CRITERIA SUSPECT SEPSIS 1 out of 3 parameters is an indication for antibiotic therapy: NNF CRITERIA SUSPECT SEPSIS 1 out of 3 parameters is an indication for antibiotic therapy PREDISPOSING FACTORS like PROM, Foul smelling liquor, amnionitis, gastric aspirate showing polymorphs 5 / HPF POSITIVE SEPSIS SCREEN (2/4 parameters) TLC <5000 per cubic ml Bandemia 20% CRP >10 ng per ml Micro ESR >10mm fall in 1hr CXR showing PneumoniaPowerPoint Presentation: Neonatal Sepsis Pathogenesis Infection in the birth canal Colonization of skin, umbilical stump, nasopharynx, conjunctiva, etc. Transient bacteremia Invasion of blood stream Metastatic foci Meningitis, etc.PowerPoint Presentation: Neonatal Sepsis Risk factors for Late onset sepsis (LOS) Prolonged hospitalization Prematurity LBW Previous antibiotic use Invasive procedures Presence of foreign material (ET Tubes/ catheters) Lack of disposables Over crowding / understaffingPowerPoint Presentation: Neonatal Sepsis Risk factors for Community acquired sepsis Bottle feeding Poor hygiene Poor cord care Over crowdingPathogenesis ... : Pathogenesis ... SIRS CARS MARSInfection : Infection Systemic Inflammatory Response Syndrome (SIRS) Resp : Tachypnoea > 2 SD Hypoxia PaO 2 < 70 mm Hg CVS : Tachycardia > 2 SD Hypothermia < 2 SD or hyperthermia Peripheral Perfusion: Delayed Capillary Filling > 3 Sec. Oliguria < 0.5 ml / kg / hr Lactic acidosis Altered mental status Increased or decreased white blood count:Infection > SIRS: Infection > SIRS Sepsis – Systemic response to infection with bacteria : SIRS with hypotension Severe Sepsis – Sepsis with organ dysfunction, hypoperfusion or hypotension Changes in mental status, oliguria, hypoxemia or lactic acidosisPowerPoint Presentation: Septic shock – Severe Sepsis with persistent hypotension despite adequate fluid resuscitation Multiple Organ Dysfunction Syndrome (MODS) – Presence of altered organ function such that homeostasis can not be maintained without intervention DeathPowerPoint Presentation: Local pro-inflammatory response Local anti-inflammatory response Initial insult (bacterial, viral thermal, traumatic) Systemic spillover of pro-Inflammatory mediators Systemic spillover of anti-Inflammatory mediators Systemic Reaction SIRS : Pro CARS : Anti MARS : Mixed C H A O S C V Compromise H omeostasis A ptosis M O DS S uppression of immunityClinical Features: Clinical Features General : Lethargy, jaundice Temperature instability Respiratory Distress after a period of normalcy Apnea GI: Poor feeding, vomiting, abdominal distention, bilious aspirates Temperature labiality Skin: Petechial rashes, bleeding from puncture sites Sclerema CNS: Lethargy, irritability, seizures Metabolic: Unexplained metabolic acidosis Hyperglycemia Hypoglycemia Features to system involvementPowerPoint Presentation: Neonatal Sepsis Total neutrophil count & Immature to total ratio: TWBC : < 5000 / micro liter or >24000 Tot. neutrophil count : < 1000 / micro liter ( Normal= 1,750 / m L ) Band / Total Neutrophil : > 0.2 ( Normal = 0.16 in 1 st Day, 0.12 after 24 Hrs.) Platelet Count : < 1 Lakh /mm 3 (Normal = 1.5 to 4 Lakhs /m m 3) - Increased risk of infection Repeat TWBC & DC at 8 - 12 hrs in a symptomatic neonate may have more predictable value than single record.PowerPoint Presentation: Neonatal Sepsis Cultures Blood Urine CSF ( For Late Onset type)] Two positive cultures are more significantPowerPoint Presentation: Neonatal Sepsis Chest X-Ray Persistent focal changes with infiltrative process Findings similar to RDS in GBS infectionPowerPoint Presentation: Neonatal Sepsis Acute Phase Reactants - Sepsis Screen Positive CRP ( > 6 mg/ L or 10 times normal) Elevated hepatoglobin level Micro ESR After 14 days of age 15 mm or more for the first hour is abnormal. (Normal ESR = Age in days + 2) If all results are -ve : Probability that infection absent = 99% If all results are +ve : Probability of infection = 90%PowerPoint Presentation: Neonatal Sepsis Grams Stain of gastric aspirate If > 5 neutrophils / hpf or Large number of bacteria (esp. Gram+ve cocci) in large clumps and chains Positive Result : Predictive value lessPowerPoint Presentation: Neonatal Sepsis Antigen detection methods Latex particle agglutination assays for GBS and ECK1 Counter immunoelectrophoresisPowerPoint Presentation: Neonatal Sepsis Lumbar Puncture Valuable in symptomatic infants who have risk factors for sepsis. CSF studies prior to antibiotic therapy is preferable Caveat: LP in RDS is difficult Interpretation is difficult if LP is traumatic Sometimes meningitis may be present with normal CSF pictureNormal Neonatal CSF: Normal Neonatal CSF TEST TERM PRETERM WBCs (per cm) Polymorphs Up to 30 60% Up to 90 60% Protein (mg/dL) Up to 150 Up to 150 Glucose (mg/dL) 35-120 25-65PowerPoint Presentation: Neonatal Sepsis Miscellaneous Investigations DIC Profile Culture of catheters/ ET Tubes Maternal vaginal swab cultures, etc.PowerPoint Presentation: ManagementSupportive therapy: Supportive therapy Thermoneutral environment IV Fluids Electrolyte and acid base balance Maintain oxygen saturation Circulatory support Glucose homeostasis Treat anemia with packet Rbc Treat bleeding diathesis with FFP / plateletsPowerPoint Presentation: Antibiotic TherapyAntibiotic Therapy: Antibiotic Therapy PROM > 12 hrs. Evidence of Chorioannionitis Delivery outside labour room Infants with 1 major or 2 minor risk factors Positive Sepsis Screen Indications:Factors to be considered in the choice of Antibiotic: Factors to be considered in the choice of Antibiotic Gram + ve Gram _ ve AnaerobesAntibiotic Selection: Antibiotic Selection Presumptive therapy directed to most commonly encountered pathogens. 1 st Line : Ampi / Sulbactum+Aminoglycoside 2nd Line: 2nd gen. Cephalosporins + Aminoglycosides 3rd Line: Vancomycin + Cephalosporins Newer antibioticsDuration of Antibiotic Therapy: Duration of Antibiotic Therapy Culture Positive Sepsis 14 Days Pyogenic Meningitis 21 Days / 2 weeks after CSF sterile Culture – ve / clinically probable sepsis screen + ve : 7-10 days Culture – ve / clinically probable sepsis screen - ve : 5-7 days Septic Arthritis 6 WeeksInvestigational therapies: Investigational therapiesSupportive Therapy: Supportive Therapy Continued Breast Feeding Nutrition : TPN / Aminoplasma Fluid / Electrolyte balance Treatment of acidosisPreventive Aspects of Neonatal Sepsis: Preventive Aspects of Neonatal Sepsis Obstetric Management strategies Screening based approach Risk factor approach Exclusive breast feeding No prelacteals Keeping the cord dry Hand washing by care givers before and after handling the baby (Single most effective measure) Hygiene of the baby Avoid unnecessary intravenous fluids, needle pricks etc.PowerPoint Presentation: Risk Factors Previous GBS Preterm delivery Bacteremia Rectal & Vaginal swab c/s. at 35-37 wks. Risk Factors Intrapartum Temp. PROM > 18 hrs No intrapartum prophylaxis needed Give intrapartum penicillin Give intrapartum penicillin Give intrapartum penicillin Algorithm for early prevention of GBSPowerPoint Presentation: Than Q -CSN Vittal You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.