Neonatal Sepsis
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Introduction
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Bacterial causes:
- 60% group B strep (GBS) or E. coli
- also Staph. aureus, Klebsiella, Enterobacter, Serratia, Citrobacter, Pseudomonas, Staph. epidermidis, Alpha hemolytic strep, Listeria, Enterococcus
- less commonly, Strep. pneumoniae, Neisseria meningitidis, H. influenza
Viral causes:
- Herpes simplex: type I (15%) and type II (85%)
- TORCH
- others
Risk factors for infection include:
- prolonged rupture of membranes (>24h gives a 1% risk of sepsis)
- chorioamnionitis: clinically, maternal fever >38C, uterine tenderness, foul odor, fetal tachycardia
- PROM + chorio: 3-5% risk of sepsis
- preterm PROM: 10% risk
Pathophysiology
Signs and Symptoms
- history
- physical exam
History
Parents will often say "baby is just not right"
Less commonly
- vomiting, diarrhea
- jaundice
- seizures
Physical Exam
greay undertone to skin
increased or decreased temperature
Tachypnea (>60)
increased work of breathing
lethargy or poor feeding
low neurological tone
less commonly
abdominal distension, hepatomegaly
apnea
petechia
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
CBCN
CRP
blood cultures (often false negative)
LP for CSF can be positive, even if blood culture negative
viral cultures
urinalysis/C&S - rarely positive in a neonate
Diagnostic Imaging
Chest X-ray
Differential Diagnosis
Treatments
Treat empirically with a minimum of 48h IV amp and gent, or longer if clinical suspicion or positive test results.
Consequences and Course
Resources and References
Topic Development
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