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
? 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
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
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,GI,Respiratory,Renal,
Cardiovascular,CNS,Hematological
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
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.
Prevention
? Prevent intrauterine infections,maternal immunization
? Proper care of umbilical cord,tetanus,omphalitis
? Intrapartum chemoprophylaxis,GBS,Chlamydia
? Aggressive treatment of maternal chorioamnionitis
? Prevention of neonatal nosocomial infection:
? 2-min scrub before entering the nursery;
? 15-sec washing between patients;
? Scrub suits for nurses and residents;
? Adequate nursing staff;
? Avoidance of overcrowding;
? Equipment sterilization;
? Specific isolation precautions;
? Antimicrobial prophylaxix
Life Support,
Your Support!
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
? 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
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
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,GI,Respiratory,Renal,
Cardiovascular,CNS,Hematological
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
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.
Prevention
? Prevent intrauterine infections,maternal immunization
? Proper care of umbilical cord,tetanus,omphalitis
? Intrapartum chemoprophylaxis,GBS,Chlamydia
? Aggressive treatment of maternal chorioamnionitis
? Prevention of neonatal nosocomial infection:
? 2-min scrub before entering the nursery;
? 15-sec washing between patients;
? Scrub suits for nurses and residents;
? Adequate nursing staff;
? Avoidance of overcrowding;
? Equipment sterilization;
? Specific isolation precautions;
? Antimicrobial prophylaxix
Life Support,
Your Support!
