NEONATAL INFECTIONS, NOENATAL SEPSIS, OPTHALMIA

NEONATRUM & CONGENITAL SYPHILLIS

BY : NIKETHANA.R.NAIRM.Sc (NURSING) II YEAR,

SRMC.

Anti microbial selection1. E.Coli, Klebsiella, Shigella & Salmonella :

Amnioglycorides or 3’rd generation Cehalosponis.2. Haemophilus Influenza : Ampicillin & 3’rd generation

Cehalosponis. Sometimes ampicillin are resistant.3. Pseudomonas : Amnioglycorides + anti pseudomonas

pencillin.4. Bacteroides Fragilis : Metronidazole, clindamycin, some

beta lactomoses such as imipenum & ampicillin with sulbactim & chloramphenicol.

Group B Streptococcus

Group b streptococcus hemolytic streptococci were

unknown to the perinatal scene until there early

1970’s where they replaced E.Coli as the single most

common agent associated with bacterial meningitis

during the 1’st 2 months of life.

Pathophysiology

Intensity of the maternal colonization is directly

Related to risk of invasive disease in the neonate

because of low & high density colonization

Risk of amniotic fluid contaminated with meconium or

vernix caseosa which promotes the growth of the GBS

& E.Coli

Conts…. Few organisms in the vaginal vault due to the PMOM

Possibly contributing to the paradox.

Organisms usually reach the blood stream by fetal

aspiration or swallowing of the contaminated amniotic fluid

Leading to bacteremia.

Escherichia Coli

E.Coli is a gram negative, non spore forming

motile rod. It is a normal inhabitant of the

gastro intestinal tract & most common cause

of the gram negative infection in the new

born.

Listeria Monocytogenes

1. It is found in the birds & mammals, including domestic

and farm animals.

2. It is found in the unpasteurized milk, soil and fecal

matter.

3. The infection appears to be undiagnosed and an

underreported cause of the congenital infection.

Neonatal meningitis

A neonatal bacterial meningitis is the

inflammation of the meninges due to

the bacterial invasion. Meningitis can

be a sequence of the new born

infection.

Toxoplasmosis

The importance of the parasite

toxoplasma gondii was discovered by

health care worker through the

perinatal death.

Management1. Prevention & early recognition.2. Mother at a risk should avoid soil digging, handling

or cooking under cooked meat.3.If the signs of infection exhibit then report

immediately.4.Congenital toxoplasmosis : Pyrimethamine +

Sulfonamides. 2mg/kg/day, orally for 2 days, followed by 1mg/kg/day for 2 or 6 months, then 1mg/kg/day every Monday, Wednesday and Friday for a year period.

Conts…

5.Doses of 100mg/kg/day is divided into 2 doses for 1 year.

6.Levovorin 10 mg is given 3 times weekly & for 1 week

after Pyrimethamine therapy.

7.Corticosteroids are given in the form of predinose at 1

mg/kg/day in 2 divided doses until there is a resolution

of elevated protein in CSF.

RUBELLA

Congenital rubella is a viral infection

acquired from the mother during

pregnancy. It has been established

that the rubella virus can be

responsible for other abnormalities.

Management 1.Avoid pregnancy for atleast 2 months after

immunizations to decrease the risk of rubella syndrome.

2.If the women receives rubella or RHoGAIG (RhIG). The vaccine may not trigger an immune response because blood products & RHoGAIG have pooled sera that may contain antibodies against rubella. Thus the women does not produce antibodies.

3.Trites should be drawn between 6 weeks after the vaccination or at most after 3 weeks.

Conts….

4.Vaccination is not recommended in pregnancy

but in case if they don’t wish to continue the

pregnancy they go for the vaccination.

5.Avoid contacts with the patients.

6.Follow up for the children for the cardiac

problems & cataracts should be done.

Cytomegalo virus

Infection with cytomegalovirus, a member of

the herpes family, is common. CMV is a DNA

virus covered with a glycoprotein coat that

closely resembles the herpes & varicella zoster

virus. CMV infection is more prevalent in lower

economic group & especially common in the

developing countries.

HERPES SIMPLEX VIRUS

Introduction

Neonatal herpes simplex virus infection is

usually transmitted during delivery. HSV is a

member of a family of the large DNA virus.

They contain linear, double strands of DNA.

The herpes family also includes CMV,

Varicella-Zooster & Epstein-Barr Virus.

Management 1. Antiviral drug: Acyclavir & Vidarabine.

2. Vidarabine: 15-30mg/kg/day/IV, over a period of 10-14

days for 12 hours.

3. Acyclavir: 30mg/kg/day/IV divided over 8 hours for 10 to

14 days. it helps in decreasing the reactivation of the virus

particularly in the treatment of herpes simplex

encephalitis.

4.Eye: Trifluridine, 1 drop every 2 hours, as well as IV therapy.

Other’s

1.Isolation : viral shedding provides an reservoir

for infecting others.

2.Family education & support.

3.Hand washing techniques.

4.Positive cultures at birth may just reflect

colonization, cultures should be repeated at 24

to 48 hours.

Hepatitis virus

It is a double stranded DNA containing

virus exposure to infected blood & body

fluids, percutaneous introduction of

blood & administration of infected

blood products are the principal routes

of transmission.

Chlamydia

Chlamydia trachomatis infection has

been identified as causing significant

increase in the incidence of PROM,

the number of low birth weight babies

and the rate of infant mortality.

Candida Albicans

It is the more prevalent form in the

neonates. Candida organisms are oval,

yeast like cells that can bud to reproduce

C-Albican producers endotoxican,

hemolysis, pyrogen & protrolytic

enzymes that are damaging to the tissues.

TEAM WORK