Neonatal sepsis – Health of the children has been considered as the vital importance to all societies because children are the basic resource for the future of humankind. Nursing care of children is concerned for both the health of the children and for the illnesses that affect their growth and development. The increasing complexity of medical and nursing science has created a need for special area of child care, i.e. pediatric nursing.
Pediatric nursing is the specialized area of nursing practice concerning the care of children during wellness and illness. It includes preventive, promotive, curative and rehabilitative care of children. It emphasizes on all round development of body, mind and spirit of the growing individual. Thus, pediatric nursing involves in giving assistance, care and support to the growing and developing children to achieve their individual potential for functioning with fullest capacity.
Neonatal sepsis
Neonatal sepsis is a clinical syndrome characterized by systemic signs of infection in association with a positive blood culture in the first month (28 days) of life.
[Ref- Piyush Gupta/1/233]
Or,
Systemic bacterial infections are known by the generic term neonatal sepsis (NNS), which incorporates septicemia, pneumonia and meningitis.
[Ref-Vinod K Paul/8/163]
Or,
Neonatal sepsis is the term that has been used to describe the systemic response to severe infection in the first month of life.
Or,
Neonatal sepsis is a type of neonatal infection and specifically refers to the presence in a newborn baby of a bacterial blood stream infection (BSI) (such as meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of fever.
Risk factors for neonatal sepsis:
a. Risk factors for EONS (Early onset neonatal sepsis):
- LBW/prematurity.
- Material fever <2 week.
- Foul smelling liquor
- Muconium stained liquor
- Prom>24 hours.
- 3 per vaginal exam during labour.
- Prolonged and/or instrumental delivery.
b. Risk factors for LONS (Late onset neonatal sepsis):
- NICU admission.
- LBW/prematurely.
- Invasive procedures.
- Parenteral fluid therapy.
- Ventilation.
- Poor umbilical care.
- Prelacteal feeding/Bottle feeding.
Causes/etiology of neonatal sepsis:
1. Bacteria: Group B streptococci (GBS), E. coli, Listeria, Pseudomonas.
2. Viruses: HSV, Enterovirus, Adenovirus.
3. Fungi: Candida.
4. Protozoa: Plasmodium, Toxoplasma.
[Ref-M. R. Khan 27/4]
Clinical features of neonatal sepsis:
i. Mostly nonsnecitic:
- Hypothermia or fever.
- Unable to suck.
- Poor cry, lethargy or abnormally sleepy.
- Hypothermia or fever.
- Poor perfusion.
- Hypotonia.
- Absent primitive reflex.
ii. Specific clinical feature:
a. Central Nervous System:
- Irritability.
- Tremors, seizures.
- Hypoflexia, moro reflex
- Irregular respirations
- High pitched cry.
b. Gastrointestinal System:
- Abdominal distension.
- Vomiting.
- Diarrhoea.
- Hepatomegaly.
c. Cardiovascular System:
- Tachycardia.
- Hypotension.
- Bradycardia.
d. Respiratory System:
- Apnea, dyspnea.
- Tachypnea, retraction
- Flaring, grunting.
- Cyanosis.
e. Renal System:
- Oliuria or anuria.
f. Hematologic System:
- Jaundice.
- Splenomegaly.
- Pallor.
- Petechiae, purpura.
- Bleeding.
g. Skin changes:
- Mooting, sclerema, multiple pustules, periumbilical redness or foul smelling
- Umbilical discharge
[Ref-M. R. Khan 28/4]
Complications of neonatal sepsis:
➤ Immediate:
- A number of failures:
✔ Cerebral failure (cerebral edema or thrombosis)
✔ Respiratory failure as a result of ARDS
✔ Pulmonary hypertension & cardiac failure
✔ Renal failure due to hypovolemia
✔ Hepatocellular failure with hyperbilirubinemia canotati
✔ Adrenal failure
✔ Bone marrow failure (thrombocytopenia, neutropenia, anemia)
- Sepsis, shock & DIC
b. Late:
- Hearing loss
- Abnormal behavior
- Developmental delay.
- Cerebral palsy
- Epilepsy
- Hydrocephalus
[Ref-M. R. Khan 4th]
Treatment of Neonatal Sepsis:
A. Supportive care:
1. Maintenance of temperature (incubator, wrapping).
2. Fluid and Nutrition (20% less):
✔ IV nutrition for very sick babes.
✔ Not tube feeding.
✔ Breast feeding.
3. Oxygen inhalation, if necessary.
4. Provides gentle physical stimulation, if baby is apneic.
5. Hypoglycamia should be treated with 10% dextrose.
6. Control of convulsion, correction of metabolic acidosis, hypocalcemia.
7. In septic shock, volume expander plus dopamine should be given.
8. Exchange blood transfusion, if
✔ Sclerema
✔Severe jaundice.
✔ DIC etc.
9. In DIC-FFP( Fresh frozen plasma), vitamin K, platelet infusion & Exchange blood transfusion.
10. Monitor for SIADH
11. Care of the umbilicus.
B. Antimicrobial therapy:
1. Empirical therapy ampicilin plus gentamicin, or ampicilin plus cefotaxine, then
2. According to C/S reports-
Duration: 7-10 days or at least 5-7 days after a clinical response has occurred.
3. For meningitis
✔ Gram +ve bacteria -14 days.
✔ Gram-ve bacteria -21 days.
C. Host defense modulation:
1. Granutocyte transfusion.
2. Immunotherapy (IVIG): 250 mg/kg/day IV over 2-4 hr for 4 days.
[Ref-M. R. Khan 28/4]
Prevention of Neonatal Sepsis By:
1. Mother should be under proper antenatal care & sign of premature leakage of membrane then treat with proper antibiotic (broad spectrum).
2. Baby should be born through an aseptic way. After birth, put the baby on a warm sterile cloth on a tray.
3. Keep the baby warm & clean.
4. Less handling of baby by relatives
5. Hand washing before handling the baby.
6. Early diagnosis of infection & early Rx of infection with Ampicillin, Cloxacillin or penicillin-Gentamycin.
7. After birth, the cord should be cut by a sterile blade & cleaned daily with rectified spirit until it drops off.
8. Care of the eye to prevent conjunctivitis: Before the baby opens the eyelids, eyes should be cleaned with sterile wet swabs. Silver nitrate solution (1%) or freshly prepared penicillin drops should be installed into eyes.
9. Baby may acquire infection from birth canal of mother so treat mother of any infection of birth canal.
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