Neonatal Sepsis

A clinical phenomenon known as neonatal sepsis is characterized by infection-related signs and symptoms in the first month of life, either with or without bacteremia (Journal of Clinical Neonatology ). It covers a range of infant systemic diseases, including septicemia, meningitis, pneumonia, osteomyelitis, arthritis, and urinary tract infections. Typically, conjunctivitis and oral thrush are not included in the definition of newborn sepsis.

Causes 

• In a hospital, escherichia coli, klebsiella, and staphylococcus aureus were found.

Types

Neonatal sepsis can be classified into two major categories depending upon the onset of symptoms:

• Early-onset sepsis (EOS): Within the first 72 hours of life, it manifests. The newborn may exhibit symptoms upon birth in serious circumstances. The most common symptoms of EOS in infants are pneumonia and respiratory distress. Usually, the mother's vaginal tract is where the infection originates. A higher incidence of EOS has been linked to a few maternal/perinatal disorders. Understanding these possible risk factors would aid in the early detection of sepsis.

Based on the studies, the following risk factors seem to be associated with an increased risk of early-onset sepsis:

• Low birth weight
• Within two weeks following delivery, the mother experienced a febrile sickness with bacterial infection signs.
• liquor that smells bad and/or is meconium-colored. >24-hour membrane rupture
• During labor, one unclean vaginal examination or more than three sterile ones
• Long-term labor (first and second stage totals exceed 24 hours)
• infant asphyxia (Apgar score)

Three of the risk indicators listed above or the presence of foul-smelling alcohol justifies starting antibiotic therapy. Infants who have two risk indicators should have an investigation and receive the appropriate care.

• Late-onset sepsis (LOS): IIt typically shows up 72 hours after birth. Nosocomial (hospital-acquired) or community-acquired infections are the sources of infections in LOS, and newborns typically present with septicemia, pneumonia, or meningitis. Numerous elements include the following that raise the risk of nosocomial sepsis:
  • Low weight at birth.
  • Prematurity.
  • Entrance into the intensive care unit.
  • Invasive procedures, parenteral fluid administration, mechanical ventilation, and the use of stock solutions.
  • Poor sanitation, inadequate cord care, bottle-feeding, and pre-lacteal meals are among factors that may raise the risk of community-acquired LOS. Contrarily, breastfeeding aids in infection prevention.

Pathophysiology

• Baby nursing from a bottle.
• Bottle contamination brought on by a caregiver's hands.
• Organism enters the digestive system.
• Systematic bacterial infection results from colonization of an organization by organisms that enter the bloodstream.
• Septicemias.

Clinical Features

• Non-specific features: Early identification of sepsis requires a high threshold of suspicion because the condition's first symptoms are frequently elusive and subtle. The following symptoms and signs could appear in newborns with sepsis:
  • Fever or hypothermia (formerly is more common in preterm low birth weight infants)
  • Laziness, a weak cry, and an unwillingness to sucking
  • Capillary filling time was delayed by poor perfusion.
  • Absence of newborn reflexes and hypotonia
  • Brady/tachycardia
  • Breathing difficulties, apnea, and gasping for air
  • Hypo/hyperglycemia
  • Acidosis of metabolism.
• Specific features related to a various system:
• Central nervous system (CNS): Increased irritability, a swollen anterior fontanelle, a vacant stare, a high-pitched wail, convulsions, and neck retraction. If these symptoms are present, there should be a clinical suspicion of meningitis.
• Cardiac: Shock, inadequate perfusion, and hypotension.
• Gastrointestinal: Intolerance to food, nausea, vomiting, diarrhea, constipation, paralytic ileus, and necrotizing enterocolitis.
• Hepatic: Hepatomegaly, direct hyperbilirubinemia (especially with urinary tract infections).
• Renal: Acute renal failure.
• Hematological: Bleeding, petechiae, purpura.
• Skin changes: Multiple pustules, abscess, sclerema, mottling, umbilical redness, and discharge.

Diagnosis

• History: Maternal health, feelings toward the child, and previous deliveries.
• Physical examination.
• Blood tests: Total, differential, culture, blood sugar, hemoglobin, and peripheral smear are all counts.
• Lumber puncture.

Management

• Place the infant in an institution.
• Warmth is provided; weigh the infant.
• For the first 12 hours, set up an IV line and administer fluids at a maintenance level in accordance with the baby's age. 10% glucose should be infused starting at 2 ml/kg.
• obtaining samples for tests such as hemoglobin analysis, peripheral smear, blood culture, and blood count.
• By applying pressure to the sternum for three seconds, check the capillary refill time and watch for the refilled area. It should take three seconds to refill.
  • Infuse 10ml/kg of normal saline if the refill time is delayed, indicating poor perfusion or shock. beyond 5 to 10 minutes. In the event that perfusion remains subpar, repeat the same dose.
  • Start using maintenance fluid if capillary refill time is normal. Dextrose 10%.
• If vitamin K hasn't been administered already, inject 1 mg of it intramuscularly.
• Place a nasogastric tube and keep the infant from eating or drinking.
• If cyanosis is present, begin oxygen therapy using a hood or mask.
• If apnea is present, give mild physical stimulation.
• acquire a chest x-ray.
• If the child's condition worsens or meningitis is suspected, start an antibiotic regimen with ampicillin and gentamycin and continue with ceftriaxone and amikacin. according to the results of the blood culture.

Assess baby’s condition over six hour’s for improvement:

If the situation has improved after three days of treatment, keep going for a total of ten days to finish the prescribed amount. If the infant is convulsing and meningitis is suspected, then:

• Correct hypoglycemia.
• For convulsion:
  • 20mg/kg of phenobarbital administered intravenously over five minutes slowly, or 20mg/kg administered intramuscularly if the IV line is not open
  • Give 19 mg/kg of phenobarbitone intravenously over a period of five minutes if the convulsion does not stop after 30 minutes, and repeat if necessary after another 30 minutes.
  • Give phenytoin 20 mg/kg intravenously if the seizure persists or happens again within six hours.
• Infuse the phenytoin at a rate of 0.5 ml per minute for 30 minutes after mixing it with 15 ml of normal saline. (phenytoin crystallizes if other fluids are used to inject it.)
• Suspected meningitis:
  • Perform a lumber puncture and send CSF for gram stain, culture, sensitivity, and cell count analysis.
  • Give the baby ceftriaxone and gentamicine, and adjust your treatment plan based on the results of the culture test.
  • Measure your hemoglobin every three days while you're in the hospital and again when you get out. Transfuse blood if the hemoglobin level is less than 11 g/dl.
• After stopping the antibiotics, keep an eye on the infant for 24 hours.
• If sepsis symptoms return, repeat the culture and administer more antibiotics.

Nursing Care of Baby with Sepsis

• Assess the baby's status right away, paying attention to things like color, movement or convulsions, heart rate, respiration, temperature, weight, bleeding, and shock symptoms.
• Place the infant in a hospital and begin immediate intervention.
• preserve the thermal environment.
• monitoring and oxygen administration.
• Open the IV line and administer fluids to maintain and stop hypoglycemia.
• the early detection of complications
• specific handling of the problem.
• proper medication as directed by a doctor.
• Adopt measures to prevent infection.
• Parental psychological support.

REFERENCE

Assuma Beevi, T.M (2009). Textbook of pediatric nursing Reed Elsevier (P) Ltd.

Hockenberry,M.J. (2004). Wong’s essential pediatric nursing (7th ed.).

Journal of Clinical Neonatology . 30 April 2011. 2015 <http://www.jcnonweb.com/article.asp?issn=2249-4847;year=2015;volume=4;issue=2;spage=149;epage=149;aulast=Mohanty>.

Marlow, D. R, & Pedding, B. A. (1988). Textbook of pediatric nursing.Philadelphia: W.B. Saunders

Medigoo.com. 2016. <https://www.medigoo.com/articles/neonatal-sepsis/>.

MedlinePlus. 26 april 2016 <http://salud.wikiplus.org/medlineplus/ency/article/001563.htm>.

Scribd. 27 September 2010. 2017 <https://www.scribd.com/document/38215390/Sepsis-in-the-Newborn>.

Tuitui, Roshani. Manual of Midwifery III. Kathmandu: Vidyarthi pustak Bhandar, 2014.