Neonatal Sepsis

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Neonatal Sepsis

• Sunhwa J. Kim, MD
• Neonatology Fellow

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Case Study

• 38 weeks GA male infant born to a 18yo G1P0
  mother. Mothers prenatal labs were rubella
  immune, VDRL nonreactive, HepBsAg negative, GBS
  unknown. Membranes ruptured 20 hours before
  infant was delivered. No maternal fever. Mother
  received 1 dose of penicillin 2 hours before the
  infant was born.

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• Infant was born via spontaneous vaginal delivery.
  Initially did well with APGARS of 8 and 9. At
  30 mins. of life, infant began to have tachypnea
  and intermittent grunting. Temperature ranged
  from 36-38C. Infant also reported to take 20ml
  of formula, but had emesis of 10ml.

4

• What other information would you like to know?
• What studies would you like to obtain?

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Incidence

• 2 bacterial infection in utero
• 1/1000 term live births
• 1/250 preterm babies
• Delayed treatment? up to 25 mortality.

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Risk Factors

• GBS status (unknown or positive)
• Insufficient amount of antibiotics given to
  mother
• 2 doses at least 4 hours before delivery
• Maternal fever
• Rupture of membranes gt 18 hours

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Possible Organisms

• Gram positive organisms
• GBS, Listeria, Staph Aureus
• Gram negative organisms
• E. Coli, Klebsiella, Pseudomonas
• Other
• Herpes, Varicella, Hepatitis

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Work up

• CBC with manual differential
• Blood culture
• Urine culture
• Lumbar puncture
• Blood glucose level
• Chest X-ray
• Blood gas

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Treatment

• IV antibiotics
• Gram Positives
• Ampicillin, Nafcillin, Vancomycin
• Gram Negatives
• Cefotaxime, Gentamicin, Tobramycin, Piperacillin
• Other
• Acyclovir
• IVIG (immunoglobulins)
• Isolation?