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Neonatal Sepsis

By

Dr. Nahed Said Al- Nagger

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Objectives: Define neonatal sepsis.1. List the causes make neonates susceptible

to infection.2. State the modes of transmission.3. Write common predisposing factors to

neonatal sepsis.4. Discuss the assessment criteria for each

body systems.5. Describe the management of neonatal

sepsis.6. Design plan of nursing care for baby has

neonatal sepsis.

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Definition

• Sepsis or "septicemia" refers to a generalized bacterial infection in the blood–stream.

• Neonatal sepsis occurs when bacteria or their poisonous products, known as endotoxins,

• gain access to the blood–stream, causing systemic signs and symptoms.

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Why neonates are susceptible to infection?

They have immature immune system. Poor response to infectious agents. There is usually no local inflammatory

reaction at the portal of entry to signal an infection and the resulting symptoms tend to be vague and nonspecific

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• Modes of Transmission

during:

- The prenatal period from maternal blood stream through the placenta.

• The natal period from infected amniotic fluid,

• or infection from birth canal (vagina or cervix).

The postnatal period through

contamination from:- other infants, personnel, - or subjects in the environment, such as,

mechanical ventilators and venous and arterial catheters used for infusions, blood sampling.

Common Predisposing Factors to Neonatal Sepsis:Maternal Factors: early sepsis less than 3 days after birth:

Premature rupture of membranes.

Intrapartum fever more than 38oC.

Premature labor.

Antenatal or antepartum asphyxia.

Maternal urinary tract infection.

Prolonged rupture of membrane more than 18 hours.

Neonatal Factors causing late sepsis 1-3 weeks after birth:

Prematurity.

Neonates with Endotracheal tubes, central lines,

I.V. catheters,… etc.

Neonates who are formula fed.

Prolonged hyper alimentation.

Current neonatal diseases.

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Neonatal Sepsis Perinatal asphyxia. Congenital defect.

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• Assessment Criteria

(Clinical Manifestations)

General signs:

"Failure to do well", "does not look right".

Unexplained respiratory distress.

Refuse to suckle.

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• Respiratory distress:

Tachypnea or apnea.

Irregular grunting respiration

Flaring nostrils.

Chest retractions.

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Gastric distress:

Vomiting (vomitus may be bile stained).

Diarrhea.

Abdominal distention.

Absent stool as a result of paralytic

ileus.

Poor sucking and feeding.

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Skin manifestations may include:

Cyanosis or pallor.

Mottling.

Purpura.

Jaundice.

Lesions associated with specific

organisms.

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Central nervous system involvement:Irritability.

Apathy.

Tremors.

Convulsions.

Coma.

Meningitis.

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• N.B.

Fever frequently absent, body

temperature commonly normal or

subnormal.

Indication of local inflammatory response

is rare.

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Diagnostic Tests:

Diagnostic tests should be obtained before initiating the antibiotic therapy, such as,

•Blood.

•Urine.

• Tracheal.

•Cerebrospinal fluid culture.

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Therapeutic Management:• Initiating therapy even before reassuring the

results:

• A. Aggressive Administration of Antibiotics:

• Before antibiotic administration, culture

should be carefully obtained.

• The recommended antibiotics are

ampicillin, gentamycin and penicillin.

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• B. Supportive Therapy If respiratory distress or cyanosis is evident,

oxygen administration or intubation and

mechanical ventilator will be required.

Adequate hydration with intravenous fluid and

electrolytes.

Blood transfusion may be needed to correct

anemia or shock.

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Nursing ManagementNursing Diagnoses:

Risk for injury related to effect of sepsis on all body systems

Risk for fluid volume deficit related to

increased metabolic rate, and insensible

fluid loss.

Risk for thermoregulation alteration

related to stress of infection, unstable

central temperature control.

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Ineffective breathing pattern related to

pulmonary and neuromuscular immaturity

and decreased energy and fatigue.

Risk for altered nutrition less than body

requirement related to feeding intolerance

(poor sucking and feeding, vomiting and

diarrhea).

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• Planning

• The goals of nursing management are the

same as for any high- risk neonate with

special emphasis on respiratory needs to:

• Minimize the harmful effect of sepsis on

neonate and prevent complications.

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Implementation

Nursing care of the infant with sepsis is similar

to the care of any high risk infant.

The nurse's awareness of the potential modes of

transmission allows her to identify those infants

more at risk for developing sepsis.

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The nurse should:

– Observe closely the neonates who are at risk for

developing sepsis to ensure early detection as

early diagnosis and treatment can prevent

complications.

– Decrease muscle tone, activity, lack of interest

intolerance of feeding and unstable body

temperature.

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1. Follow isolation technique.2. Monitor vital signs. 3. Maintain a neutral thermal

environment.EvaluationThe effectiveness of nursing

intervention is determined by continual reassessment and evaluation of care based on observation of signs and symptoms of sepsis.