Neonatal Septicemia 多 Tongji Hospital
Neonatal Septicemia Tongji Hospital
Bacteremia and septicemia Bacteremia: a more benign infection with entrance of bacteria into the bloodstream, but in limited quantities Septicemia: an overwhelming infection with more organism or more virulent organisms that is likely to lead to shock or other complications Term of (sIrs) The neonates does not localize infection well, and secondary spread to the meninges(meningitis)or other sites Incidence ranges from 1-10 patients per 1000 live births 21040% of mortality and substantial morbidity in survival
Bacteremia and Septicemia ➢ Bacteremia: a more benign infection with entrance of bacteria into the bloodstream, but in limited quantities. ➢ Septicemia: an overwhelming infection with more organism or more virulent organisms that is likely to lead to shock or other complications Term of (SIRS) ➢ The neonates does not localize infection well, and secondary spread to the meninges (meningitis) or other sites ➢ Incidence ranges from 1~10 patients per 1000 live births ➢ 10~40% of mortality and substantial morbidity in survival
Etiology and Pathogenesis Pathogen: varies with region and time In USA and Europe: 1930s'-Group a strep 1940S'-E. Coli 1950s'-Staph aureus 1970S'-Group B Strep In China: Staphylococcus. E. Coli Opportunistic pathogens Drug resistance
Etiology and Pathogenesis ➢ Pathogen: varies with region and time In USA and Europe: 1930s’ – Group A Strep 1940s’ – E. Coli 1950s’ – Staph aureus 1970s’ – Group B Strep In China: Staphylococcus, E. Coli Opportunistic pathogens Drug resistance
Route of Infection Prenatal infection maternal bacteremia and septicemia invasive diagnostic procedures Intrapartum infection bacteria colonization in the parturient canal PROM, prolonged stages of labor Umbilical/fetal scalp sampling Postnatal infection enviroment, skin contact, medical procedures
Route of Infection ➢ Prenatal infection • maternal bacteremia and septicemia • invasive diagnostic procedures ➢ Intrapartum infection • bacteria colonization in the parturient canal • PROM, prolonged stages of labor • Umbilical/fetalscalp sampling ➢ Postnatal infection • enviroment, skin contact, medical procedures
Neonatal vulnerability Immature immune system skin/mucus membrane, low in Igg and complement, poor migration/phagocytosis, low in cytokine production y Unavoidable pathogen exposure during birth Peripartum stress Invasive procedures Exposure to highly resistant nosocomial organisms
Neonatal Vulnerability ➢ Immature immune system • skin/mucus membrane, low in IgG and complement, poor migration/phagocytosis, low in cytokine production ➢ Unavoidable pathogen exposure during birth ➢ Peripartum stress ➢ Invasive procedures ➢ Exposure to highly resistant nosocomial organisms
Clinical Manifestation Most neonates with sepsis or meningitis present with NON SPECIFIC SIGNS OR SYMPTOMS Hypothermia/hyperthermia, respiratory distress, feeding difficulties, weak suck, irritability, lethargy, apnea, abdominal distension, vomiting, diarrhea, gallbladder distension, hepatosplenomegaly, jaundice, petechiae, seizure General, Gl Respiratory, renal Cardiovascular, CNs, Hematological
Clinical Manifestation ➢ Most neonates with sepsis or meningitis present with NON SPECIFIC SIGNS OR SYMPTOMS • Hypothermia/hyperthermia, respiratory distress, feeding difficulties, weak suck, irritability, lethargy, apnea, abdominal distension, vomiting, diarrhea, gallbladder distension, hepatosplenomegaly, jaundice, petechiae, seizure General, GI, Respiratory, Renal, Cardiovascular, CNS, Hematological
Clinical Manifestation Early-Onset(0-3d-7d) Late-Onset(home)(8-28d) GBS GBS 今E.Coli Gram Negatives Listeria He erpes Others less common Late-Onset(hospital): Herpes Staph epidermidis Staph aureus Strep a and d .o Gram negatives(resistant) Pseudomonas. Klebsiella H. influenza Klebsiella Enterobacter Serratia Pseudomonas Acinetobacter Enterobacter Candida(esp. if deep line)
Clinical Manifestation ➢ Early-Onset (0~3d~7d) ❖ GBS ❖ E. Coli ❖ Listeria ❖ Others less common • Herpes • Staph aureus • Strep A and D • H. influenza • Klebsiella • Pseudomonas • Enterobacter ➢ Late-Onset (home)(8~28d) ❖ GBS ❖Gram Negatives ❖ Herpes ➢ Late-Onset (hospital): ❖ Staph epidermidis ❖ Gram negatives (resistant) • Pseudomonas, Klebsiella • Enterobacter • Serratia • Acinetobacter ❖ Candida (esp. if deep line)
Laboratory investigation Screening Test(non-specific examination) WBC counts and differentiation, immature/total neutrophils ESR Acute phase proteins(CrP, etc) Pathogen Culture Blood culture CSF/urine culture(CNs and Urinary tract infection) Skin/secretion culture Antigen for Pathogen Other molecular detection
Laboratory Investigation ➢ Screening Test (non-specific examination) • WBC counts and differentiation, immature/total neutrophils • ESR • Acute phase proteins(CRP, etc) ➢ Pathogen Culture • Blood culture • CSF/urine culture (CNS and Urinary tract infection) • Skin/secretionculture ➢ Antigen for Pathogen ➢ Other Molecular Detection
Treatment Antibiotics For infants with various high risk factors clinical indications of infection. abnormal wBc. antibiotic therapy should be institute immediately without wait Initial empirical treatment: ampicillin and an aminoglycoside(gentamicin or amikacin) ototoxicity! Nosocomial in NICU: nafcillin or Vancomycin Change according to drug sensitivity test Third-generation cephalosporins(eg Cefotaxime) Duration: 7-10 days, or 5-7 days after response 14 days for meningitis >A negative blood culture result does not preclude bacterial infection Supportive Care: energy, liquid, maintain organ function
Treatment ➢ Antibiotics • For infants with various high risk factors, clinical indications of infection, abnormal WBC, antibiotic therapy should be institute immediately without wait. • Initial empirical treatment: ampicillin and an aminoglycoside (gentamicin or amikacin) ototoxicity! • Nosocomial in NICU: nafcillin or Vancomycin • Change according to drug sensitivity test • Third-generation cephalosporins (eg Cefotaxime) ➢ Duration: 7~10 days, or 5~7 days after response, 14 days for meningitis ➢ A negative blood culture result does not preclude bacterial infection ➢ Supportive Care: energy, liquid, maintain organ function
Complications and Prognosis Complications of bacteremic infections: Endocarditis, septic emboli, abscess formation, septic joints with residual disability, osteomyelitis and bone destruction 50% mortality rate in adult, yet -20% in neonate(all bacteremic infections are included) Case fatality rate for neonatal bacterial meningitis is between 20 25% Late complications of meningitis occurs in 40-50% of survivors Hearing loss, abnormal behaviors, developmental delay, cerebral palsy, motor disability, seisure, hydrocephalus, etc
Complications and Prognosis ➢ Complications of bacteremic infections: • Endocarditis, septic emboli, abscess formation, septic joints with residual disability, osteomyelitis and bone destruction ➢ 50% mortality rate in adult, yet ~20% in neonate (all bacteremic infections are included) ➢ Case fatality rate for neonatal bacterial meningitis is between 20~25% ➢ Late complications of meningitis occurs in 40~50% of survivors • Hearing loss, abnormal behaviors, developmental delay, cerebral palsy, motor disability, seisure, hydrocephalus, etc
