Neonatal Infections

Sepsis: Refers to a generalized bacterial infection in the bloodstream

Neonates: highly susceptible to infection due to diminished nonspecific (inflammatory)
and specific (humoral) immunity
***poor response to pathogenic agents results in vague and non-specific symptoms***
Breastfeeding has protective benefit against infection will be very beneficial to high
risk neonates; colostrum is effective against gram negative bacteria (E. Coli)
Neonatal sepsis is most common in preterm infants and infants born after a traumatic
or difficult labor and delivery
**Sepsis can sometimes be mistaken for RDS**
**Complications can include meningitis and septic shock**

Transmission of Infection of Neonate

Before
In utero: across the placenta from the maternal bloodstream
Cytomegalovirus, Toxoplasmosis, Syphilis crosses placental barrier during latter half of
pregnancy
Ingestion or aspiration of infected amniotic fluid, prolonged rupture of membranes increases
this risk
Rubella, CMV, Syphilis, HIV, Toxoplasmosis
During
Passing of the baby through birth canal
Intrapartum infection may occur via contact with infected mother
examples: HIV and herpes virus

 After

Transmission of Infection of Neonate

Contracted after birth from hospital (nosocomial), other infants, personnel, objects in
environment
Hospital staff and equipment: germs
water bugs: bacteria that are able to grow in water, found in water supplies, humidifying
apparatus, sink drains, suction machines, and most respiratory equipment
Poor hand washing
Inadequate Housecleaning

 Preventative
Eye drops to prevent syphilis and gonorrhea
Hepatitis vaccine
GBS screening, including Hep B and HIV are recommended
Handwashing
Appropriate isolation precautions
Standard spacing of infant kids
HIV infected mothers: Breastfeeding is not recommended because the virus may
be transmitted through breastmilk

Sepsis Neonatorum
Systemic infection from bacteria
Common agent
Group Beta strep (GBS) in term infants, extremely virulent, high death rate
most common, before and during
can be misdiagnosed, same S&S as respiratory distress syndrome
Staph
easily spread
Influenza
Listeria
E. Coli:(gram negative) most common infecting organism in preterm infants
Candida (oral yeast infection)
thrush in babys mouth
Nystatin oral suspension-swabbed on the buccal mucosa for prophylaxis against oral candidiasis

Diagnostics
CBC with diff
elevated WBC (but it is normally elevated in infants)
increase neutrophils (left shift)
Left shift: means elevated number of immature neutrophils also called bands
increase in bands
Elevated immunoglobulin M
after birth, if this is elevated, the baby has an infection

Diagnostics

C-reactive protein rises

Inflammatory process
SIRS
Blood cultures
culture FIRST: nose, urine, CSF
determine what antibiotics to give
CSF culture- usual side lying position( modified with neck extension) or
sitting position to obtain spinal fluid
Isolation of organism through blood, urine, and CSF

Manifestations
General

temp may be low: poor temperature hypothermia or hyperthermia in neonates

presence of rash

infant generally not doing well

Respiratory

Respiratory distress -3 big symptoms: nasal flaring, grunting and retractions, tachypnea

Dyspnea, apnea, irregular respirations

CV

Discoloration of the skin, blue or pale cyanosis, mottling, pallor

Irregular heartbeat tachycardia or bradycardia

hypotension

cold and clammy skin

Edema

Manifestations
Neurologic
High pitched crying
Irritable
Muscle tone flabby (increased or decreased tone)
Fontanel full
Diminished Activity: lethargy, hyporeflexia, coma
Increased ACtivity: irritability, tremors, seizures
Abnormal eye movements

Manifestations
GI
Dont feed well: poor feeding
Vomiting, diarrhea or decreased stooling, abdominal distension, hemo-occult
positive stools
Low? Gastric residual due to not tolerating the food
Advanced infection
Liver involvement: increased bilirubin, jaundice, splenomegaly, hepatomegaly,
Ecchymosis
Septic shock
Anemia

Interventions
Prevention: Hand washing - the best prevention!!!
Disinfect equipment, proper disposal of excretion, and adequate housekeeping
Maintain sterility for invasive procedures
Antibiotics: culture and sensitivity
antibiotics are initiated before lab results are available for confirmation
Continue therapy for 7-10 days if culture is positive
D/c 48-72 hrs if negative and pt is asymptomatic
Most antibiotic are administered via IV infusion
Give antifungal and antiviral therapy as needed

Interventions
Supportive: Support the family

***Treatment consists of circulatory support, respiratory support,

aggressive administration of antibiotic, and immunotherapy***
Oxygen if pt is in respiratory distress or hypoxia is evident
Correction of fluid and electrolyte imbalance
Temporary d/c of oral feeding, oral hygiene to decrease VAP
Blood transfusion to correct anemia and shock
Monitor vital signs
regulate thermal environment-reduce physiologic and environmental stress

Infections effect on Newborn

Varicella-Zoster
It is safe for the mother to get Varicella-Zoster vaccination during pregnancy, mom will
develop antibodies and they will be passed to the baby. But she needs time to develop
antibodies. So, if she will receive vaccine right before the birth of the baby, she will not
have time to develop antibodies and the baby will get sick. But if she received vaccine
earlier at 13-20 week she will have time to develop antibodies and they will be passed to
the baby, the baby will not get sick.
If mother contracts chicken pox between 13-20 weeks, child can have congenital
problems
Small head
Scars
IUGR(intrauterine growth restriction)
Cataracts

Infections effect on Newborn

Varicella Zoster Immunoglobulin Vaccine

mother and child will need to be isolated
Group B strep
Colonizes in the vagina, rectum

Baby gets symptoms after the first week of birth

3 main things baby can get from GBS
Meningitis, pneumonia, full - blown sepsis
Meningitis- most common
Drug of choice is Penicillin, if for some reason baby cant take it the other drug
will be Ampicillin
Gonorrhea
Can cause blindness
Give prophylactic eye drops

Infections effect on Newborn

TORCH
(TOxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex)
Can have it all at once or separate
Toxoplasmosis
not very common in the US, very common in Europe
undercooked meats
poor sanitation
cats (if pregnant dont touch a litter box)
feed cat of raw food, dont let him eat raw meat or go outside to catch lizards,
mice...

Infections effect on Newborn

Rubella:
causes spontaneous abortion
Cardiac defects
Deafness
Cataracts
Virus can shed for months
PREVENTION: Rubella vaccination (MMR in a younger age) for mother
No treatment

Infections effect on Newborn

Cytomegalovirus:
Opportunistic virus
Affects people with decreased immune system
High incidence in daycare centers
Usually not harmful, unless immunocompromised, it is very common
Transmitted through kissing, sex
No treatment
Acyclovir: decrease the severity and length of time, doesnt cure
Any antiviral meds

Infections effect on Newborn

Herpes simplex:
Genital herpes
If mother has active genital herpes, she will have a C-section
Otherwise mother can have a vaginal birth
No cure-virus
Treatment:
acyclovir: decreases severity and length of time
Antibiotics
Viruses: herpes, rubella and cytomegalovirus has no cure because they are
viruses

Treatment
Broad spectrum antibiotics
Culture first, then give broad spectrum until bacteria, protozoa, or fungi is
determined
may give triple antibiotic
Oxygen
Respiratory distress
Fluid balance
hypovolemic
BP
hypotension: may give some volume
Urine output hourly
especially when dealing with BP and fluid balance

Treatment
Monitor for
Shock
Hypoglycemia
Electrolyte imbalance
Temperature regulation: usually low in babies
Isolate if needed
Handwashing: Be aware of potential modes of infection transmission
Broad spectrum antibiotics
Oxygen
Fluid balance
BP
urine output hourly
Temperature regulation