Neonatal Sepsis

Ophthalmia Neonatorum

Ophthalmia Neonatorum is defined as conjunctival inflammation during the first three weeks of life, marked by purulent discharge, edema, and redness of the affected eyes.

Causes

1. Chlamydia trachomatis is the most common cause.
2. The other cause include ;
   - bacterial: staphylococcus, pseudomonas, pneumococcal gonococcal.
   - chemical: silver nitrate
   - viral: herpes simplex

Mode of Infection

The majority of infections occur during delivery as a result of contaminated vaginal discharge. Face and breech deliveries are more likely. Direct contamination from other sites of infection or chemical contamination may occur during the neonatal period.

Sign and Symptoms

1. Eyes that are red and swollen.
2. Watery, mucopurulent to frank purulent discharge may occur in one or both eyes.
3. The eyelids may be sticky or significantly swollen.
4. In severe cases, the cornea may be implicated.

Treatment and Management

1. The contaminated baby is isolated.
2. The pus was sent for culture and sensitivity testing.
3. The treatment is determined by the cause.

Gonococcal

Every 1-2 hours, the eyes are rinsed with sterile isotonic saline until they are clear. Gentamycin eye drops are administered four times per day for seven days. In severe cases, systemic benzylpenicillin 50,000 units/kg in two divided doses is administered for 7 days, or cefotaxime 100 gm/kg daily is administered intravenously.

Chlamydia

To avoid systematic infection, erythromycin suspension 40mg/kg is given orally once a day for 2-3 weeks.

Herpes simplex 

IV acyclovir 30mg/kg daily for 2 weeks is administered as systemic treatment. For five days, apply 1% idoxuridine ointment to the affected area five times each day.

Prevention

1. Suspicious vaginal discharge should be addressed during the antenatal period, and stringent aseptic procedures should be used at birth.
2. The closed lids of a newborn baby should be carefully cleaned and dried.
3. To avoid infection, wash the baby's eyes and face with sterilized water and a swab after bathing.
4. Before touching the baby's face, the midwife and mother should always wash their hands.

Neonatal Tetanus

Neonatal tetanus is a terrible infection that has a high fatality rate. It is an acute caused by a tetanus bacilli exotoxin that grows anaerobically at the site of damage. It is distinguished by a locked jaw, impaired sucking ability, muscle spasms, and rigidity.

Tetanus has no known treatment. Treatment focuses on preventing problems until the tetanus toxin's effects wear off. Individuals who have not been immunized and older adults with insufficient immunization have the highest mortality rates.

Symptoms

• irritable and always cry
• can't suck breast milk
• repeated convulsions
• Spasms and stiffness in your jaw muscles
• Stiffness of your neck muscles
• Difficulty swallowing
• Stiffness of your abdominal muscles
• Fever
• Sweating
• Elevated blood pressure
• Rapid heart rate

Causes

Clostridium tetani, the bacteria that causes tetanus, is found in dirt, dust, and animal excrement. When bacteria spores enter a deep flesh wound, they may create tetanospasmin, a potent toxin that actively inhibits your motor neurons, the nerves that govern your muscles.

Risk factors

Furthermore, specific circumstances are required for tetanus bacteria to develop in your body. These are some examples:

• Lack of or insufficient immunization against tetanus — failure to acquire timely booster injections —
• The presence of other pathogenic microorganisms
• Tissue damage
• A foreign object, such as a nail or a splinter
• Swelling of the injured area

Tests and diagnosis

Tetanus is diagnosed through a physical exam, medical and immunization history, and signs and symptoms such as muscle spasms, stiffness, and discomfort. In general, laboratory testing is ineffective for diagnosing tetanus.

Treatments and drugs

Because there is no cure for tetanus, treatment comprises wound care, symptom relief drugs, and supportive care.

1. Wound care
   Cleaning the wound is critical for preventing tetanus spore formation. This entails cleaning the wound of debris, foreign objects, and dead tissue.
    
2. Supportive therapies
   Tetanus infection frequently necessitates a lengthy stay in an intensive care unit. Because sedatives can cause shallow breathing, you may need to use a ventilator for a while.
    
3. Medications

• Antitoxin: Tetanus antitoxin, such as tetanus immune globulin, may be administered by your doctor. The antitoxin, on the other hand, can only neutralize toxin that has not yet been attached to nerve tissue.
• Antibiotics: To combat tetanus bacteria, your doctor may also prescribe antibiotics, either orally or intravenously.
• Vaccine: Having tetanus does not render you immune to the bacterium in the future. To avoid future tetanus infections, you'll need to get a tetanus vaccine.
• Sedatives: To control muscle spasms, doctors typically employ strong sedatives.
• Other drugs: Other drugs, such as magnesium sulfate and some beta-blockers, may be used to control involuntary muscle activity, such as your heartbeat and respiration. Morphine, as well as sedatives, can be utilized for this purpose.

Nursing management

1. The neonate should be kept in a quiet, dim, and isolated area, with minimal handling.
2. If necessary, oxygen should be administered.
3. Vital statistics should be documented on a regular basis.
4. Input and output should be kept constant.
5. To clear the airways, use gentle suction.
6. Cord care should be provided and sealed with benzoin tincture.