Is this baby eligible

1

• Is this baby eligible
• for INIS?

2

• 23 weeks gestation, birth weight 475g
• Day 3 - reduced activity on ventilator, looks
  seriously ill
• Screening bloods - CRP 45mg/l,platelets 88
• Antibiotics commenced
• Confirmation of infection day 2 with GBS on blood
  culture

3
?

• 23 weeks gestation, birth weight 475g
• Day 3 - reduced activity on ventilator, looks
  seriously ill
• Screening bloods - CRP 45mg/l,platelets 88
• Antibiotics commenced
• Confirmation of infection day 2 with GBS on blood
  culture

4

• 26 weeks gestation, birth weight 950g
• Day 4, deterioration on ventilator
• Increasing oxygen requirement to 80
• Appears unwell
• ETS recently grown coagulase negative
  staphylococci and CXR consistent with pneumonia
• Antibiotics commenced

5
?

• 26 weeks gestation, birth weight 950g
• Day 4, deterioration on ventilator
• Increasing oxygen requirement to 80
• Appears unwell
• ETS recently grown coagulase negative
  staphylococci and CXR consistent with pneumonia
• Antibiotics commenced

6

• 27 weeks gestation, 1.3kg
• PROM 27 hrs
• GBS on maternal HVS
• Intrapartum antibiotics not given
• Asymptomatic infant
• Antibiotics commenced as hospital policy

7
?

• 27 weeks gestation, 1.3kg
• PROM 27 hrs
• GBS on maternal HVS
• Intrapartum antibiotics not given
• Asymptomatic infant
• Antibiotics commenced as hospital policy

8

• 27 weeks gestation, birth weight 1360g
• Day 38 intermittent bradycardias, then apnoeas
  resulting in ventilation
• Distended, tender abdomen noted with bilious
  aspirates
• Serial AXRs confirm fixed, oedematous bowel loops
• NEC diagnosed and antibiotics commenced

9
?

• 27 weeks gestation, birth weight 1360g
• Day 38 intermittent bradycardias, then apnoeas
  resulting in ventilation
• Distended, tender abdomen noted with bilious
  aspirates
• Serial AXRs confirm fixed, oedematous bowel loops
• NEC diagnosed and antibiotics commenced

10

• Term infant
• Cyanotic episodes at 2hrs age
• Increasing oxygen requirement
• CXR patchy consolidation both lung fields
• Commenced on antibiotics
• CRP 19

11
?

• Term infant
• Cyanotic episodes at 2hrs age
• Increasing oxygen requirement
• CXR patchy consolidation both lung fields
• Commenced on antibiotics
• CRP 19

12

• But
• If there was offensive liquor, raised
  inflammatory markers or this baby was to become
  unwell
• This baby would be eligible for INIS

13

• Deterioration day 34
• Recurrent apnoeic episodes
• Prolonged cap. refill time
• CRP 66
• Commenced on antibiotics
• 29 weeks gestation
• Positive blood culture

14
?

• Deterioration day 34
• Recurrent apnoeic episodes
• Prolonged cap. refill time
• CRP 66
• Commenced on antibiotics
• 29 weeks gestation
• Positive blood culture

15

• Remember
• It is NOT TOO LATE to randomise an infant after a
  positive blood culture has been reported
• IVIG may be of benefit after the inflammatory
  process has begun

16
Every baby counts

• Consider all babies to be eligible for INIS
• Make sure everyone knows you are the INIS nurse
• Make sure they know you do not have to be there
  for them to recruit a baby into INIS
• Remember an ANNP can get consent
• Doctors need to write up the prescription