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NEONATAL SEPSIS

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Neonatal Sepsis

Neonatal Sepsis is an infection in the blood that spreadsthroughout the body and occurs in a neonate. Neonatal Sepsisis also termed as Neonatal Septicemia and Sepsis Neonatorum.

Neonatal Sepsis has 2 types: The one that is seen in the first weekof life is termed as Early- onset sepsis and most often appearsin the first 24 hours of life. The infection is often acquired fromthe mother. This can be cause by a bacteria or infectionacquired by the mother during her pregnancy, a Pretermdelivery, Rupture of membranes (placenta tissue) that lastslonger than 24 hours, Infection of the placenta tissues andamniotic fluid (chorioamnionitis) and frequent vaginalexaminations during labor. The second type or the Late-onsetSepsis is acquired after delivery. This can be cause bycontaminated hospital equipment, exposure to medicines thatlead to antibiotic resistance, having a catheter in a blood vesselfor a long time, staying in the hospital for an extended periodof time.

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Signs and symptoms of NeonatalSepsis includes: breathing problems (Hyperventilation) earliest sign

body temperature changes (Chills, Fever or low bodytemperature )

low blood sugar

reduced movements reduced sucking

Seizures

slow heart rate/ Rapid heart beat

swollen belly area

vomiting

yellow skin and whites of the eyes (jaundice)

decreased urine output

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IMMUNITY Immune System Development The immune system

begins very early in fetal development with the originof blood formation in the third week of gestation. Inthe fourth week of gestation the thymus forms. Thethymus helps to mature and develop white blood cellsso that they can play a key role in fighting infections.By the eighth week of gestation, T cells, B cells, andnatural killer cells can all be found in the thymus. T

cells, which make an important component in cell-mediated immunity, are formed solely in the thymus.B cells, which are the precursors of antibody producingcells, are first produced in the liver but by 12 weeksgestation move into the bone marrow where itremains. Natural killer cells, which are cytotoxic cellsthat have the ability to attack viruses, mature in thethymus. Interestingly, greater concentrations ofnatural killer cells are found in the peripheral blood ofnewborns and the newborn usually has adult levels ofthese cells at birth, but they diminish rapidly.

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Neutrophils are relatively numerous in both the term and pre-term infant. Aneutrophil is a type of white blood cell that defends the body from organismsthat cause infection. The stages of neutrophil development, from immatureto mature, are myeloblast, promyelocyte, myelocyte, metamyelocte, band,and segmented neutrophil. When an infection is present, the neutrophils

migrate out of the capillaries and into the infected site, where they ingestand destroy the pathogens causing the infection. The amount of circulatingneutrophils in the newborn peaks around 12 hours after birth and then startsto decline to normal levels. Even though a large number of circulatingneutrophils can be found in the newborn, the bone marrow storage pool ofneutrophils at birth is only 20% to 30% of the circulating pool in adults.

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Differences in Immune Responses in Full and Preterm Infants

Immune System Component Full Term Infant Preterm Infant

Immunoglobulin G Complete placental transfer,concentrations comparable to mother Incomplete placental transfer,concentrations decreased

Lymphocytes Concentrations of T and B cellscomparable to those in adults withnormal response to antigens

Concentrations of T and B cellscomparable to those in adults withnormal response to antigens

Complement 50%-75% of concentration in adult Decreased concentration

Neutrophils Elevated numbers at birth, withimpaired functional ability

Elevated numbers at birth, withimpaired functional ability

Monocytes Normal number at birth but haveimpaired chemotaxis

Normal number at birth but haveimpaired chemotaxis

Macrophages Normal number at birth but decreasedfunction

Normal number at birth but decreasedfunction

Natural Killer Cells Concentration similar to adult level,but have diminished cytotoxic effects

Concentration similar to adult level,but have diminished cytotoxic effects

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Immune System Physiology Despite the immune system and immune system components, early

development during gestation the newborn still remains vulnerableto infections after they are born because of the immaturity of their

immune system. A newborn has a poor response to invadingpathogens. This immune response will gradually improve with age.During the initial postpartum phase, the infant relies on maternalantibodies and the mothers breast milk, which is rich withimmunoglobulins. When a pathogenic organism overcomes theinfants defenses, infection and sepsis result. Sepsis is defined asthe presence of microorganisms or their toxins in blood or othertissues. Newborn sepsis is still one of the most significant causes of

neonatal disability and death today. Reviewing the functions of theinfants immune system will help provide a better understanding ofthe interaction between the pathogenic organisms and thenewborns susceptibility to infection. Infections occur when theinfant comes in contact with a pathogenic organism. The organism,whether it is a virus, fungus, or bacteria, enters into the infantsbody system and begins to multiply. The infants immune systemresponse to an organism is divided into three phases. The first

phase is the primary or nonspecific phase, which occursimmediately following the infants inoculation with a pathogenicorganism. During this phase, there is a migration of the neutrophilsto the primary site of the infection. The neutrophils enter into thecells through membrane filters and adhere to the pathogen.Ingestion and destruction of the invading organism then takesplace.

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Risk Factors

Intrauterine:

Intrauterine or factors that increase the risk before birth include the following: poorprenatal care, poor nutrition, recurrent abortions, and substance abuse. Intrauterineinfections occur when pathogenic organisms cross the placenta into the fetalcirculatory system. The organisms, such as cytomegalovirus (CMV), can reside in theamniotic fluid,. Other organisms ascend from the vaginal track, infecting themembranes and causing them to rupture. This rupture of membranes can lead toinfections of the respiratory and gastrointestinal tract of a newborn.

Intrapartum:

Intrapartum or factors that increase the infants chance of becoming infected during thebirthing process include: prolonged rupture of membranes (>12 to 18 hours), urinarytract infections, preterm labor, prolonged or difficult labor, maternal fever, colonizationwith Group B Streptococcus (GBS), and maternal infections. Most infections during thebirthing process are related to the infant coming into unavoidable contact with aninfected birth canal. The birth canal can host bacteria that an infants immune systemcannot defend against.

Postpartum:

Postnatal infections may be contracted after delivery, as in the case with infectionscontracted during resuscitation, or as a result of a nosocomial infection due toimproper hand washing. Infections in the postnatal period are more common in thoseinfants who require foreign objects be introduced into their systems. Items likeendotracheal tubes or indwelling catheters increase the risk of an infant becomingseptic.

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Source: Risk Factors: Maternal

Intrapartum

Neonatal

Poor prenatal care

Poor nutrition

Substance abuse

Premature rupture ofmembranes

Maternal fever

Prolonged labor

Maternal UTI

Male Birth

asphyxia

Low birth weight

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Trends in Neonatal Sepsis

Mortality/Morbidity

Sepsis is a major cause ofdeath during the first fewmonths of life causing 13-

15% of all neonatal deaths.The mortality rate of neonatalsepsis can be as high as 50%for infants who are nottreated or when treatment isnot begun quickly. A seriousmorbidity of neonatal sepsis

is neonatal meningitis.Research has shown thatneonatal meningitis occurs in2-4 per 10,000 infants and ofthose infants diagnosed withneonatal meningitis theirchance of survivalsignificantly decreases. It isres onsible for 4% of all

Race, Sex, & Age

Current research has

shown that African-Americaninfants have an increasedincidence of Group B Strep(GBS) disease as well asacquired or late sepsis. To helpcounter this many professionalhealthcare groups haverecommend guidelines for

controlling risk factors in thisrace. Despite these changes inscreening and treatments,African-American infants stillremain at the highest risk forsepsis. Orlando RegionalHealthcare, Education &Development Copyright2004 Page 8 Male infants havea higher incidence of sepsis

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Treatment & DX exams

Babies in the hospital andthose younger than 4weeks old are started onantibiotics before labresults are back. (Lab

results may take 24-72hours.) This practice hassaved many lives.

Older babies may not begiven antibiotics if all lab

results are within normallimits. Instead, the childmay be followed closelyon an outpatient basis.

Blood culture is a laboratory test to check for

bacteria or other microorganisms in ablood sample

C-reactive proteinis a test that measures theamount of a protein in theblood that signals acuteinflammation.

CBC (complete blood count)

the number of red blood cells(RBCs) white blood cells (WBCs)Thetotal amount ofhemoglobin in theblood The fraction of the bloodcomposed of red blood cells (hematocrit)The size of the redblood cells (mean corpuscularvolume, or MCV)

http://www.healthline.com/adamcontent/hemoglobinhttp://www.healthline.com/adamcontent/hematocrithttp://www.healthline.com/adamcontent/hematocrithttp://www.healthline.com/adamcontent/hemoglobin

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MANAGEMENT:

Treatment begins with careful monitoring of theinfants vital signs and regulation of the thermalenvironment.

Supportive therapy for a septic infant starts with

the administration of oxygen when respiratorydistress or hypoxia becomes present.

Invasive respiratory support such as continuouspositive airway pressure (CPAP) or to be placedon a ventilator if they are suffering from apneic

episodes. Antibiotic therapy is continued for 7 to 21 days if

the cultures are positive, or it is discontinued in3 days if cultures are negative.

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NURSING CONSIDERATIONS:

Skilled observation and ongoingassessments. Recognition of a problem is

paramount in importance. It is most oftenthe nurse who observes and identifies thatsomething just isnt right with the infant.This is due to the fact that the nurse

maintains constant assessment anddocumentation of subtle changes in theinfants vital signs, physical assessments,

feeding tolerance, responsiveness, and/oreneral behavior.

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Start ing and maintaining IV access for drug therapy. Comm onsites in the infant include the hand and arm, as well as theveins found in the scalp and foot. If the infant is going torequire extensive ant ibiotic therapy, a peripherally inserted

cent ral catheter (PICC) may be considered.

Total care of infants with sepsis involves decreasing any additionalphysiologic and/or environmental stress. This includes providing anoptimum thermoregulated environment and anticipating potential

problems, such as dehydration or hypoxia.Precautions need to be implemented to prevent the spread of infectionsto other newborns. To be effective, precautions must be carried out by allcaregivers that come in contact with the sick infant. aProperhandwashing, use of disposable equipment, disposing of excretions, and

adequate housekeeping of the environment and equipment areessential.

Since nurses are the most constant caregivers involved with sickinfants, it is usually their responsibility to oversee that everyonemaintains all phases of isolation.

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DISCHARGE PLAN

M - Medication- ampicillin 150mg

-E - Exercise

- Stressed that the baby sleeps most often timesT - Treatment

- Stressed importance of complying with the medicationsH - Health Teachings- Instructed to bring back the baby in the hospital for his medication- Instructed on the time the medication will be giventhe injection site; sleeplessness; vomiting.- Instructed to expose the baby to sunlight

- Instructed that formula milk is only good for 4 hours-- Instructed to burped the baby after each feedings- Instructed to bathe daily their BabyD - Diet

-Instructed to feed the baby as tolerated with strict aspirationprecaution

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By: Group 1

Ayna Chiqui IsmaelRichmond RomboRiza Diki

Emie Joy EspaolaJesselie Lapinig