Management of Neonatal Sepsis.ppt

* * * * * * * * * Management of Neonatal Sepsis Niki Kosmetatos, MD Anthony Piazza, MD J. Devn Cornish, MD Emory University Department of Pediatrics Incidence Mortality 13-69% world wide 13-15% of all neonatal deaths (US) Meningitis 0.4-2.8/1000 live births (US 0.2-0.4/1000) Mortality 13-59%; US 4% of all neonatal deaths Sepsis 1-21/1000 world wide; US1-8/1000 live births Culture proven 2/1000 (3-8% of infants evaluated for sepsis) Prematures 1000 g 26/1000 1000 - 2000 g 8-9/1000 Predisposing Factors General Host Factors Prematurity Race – GBS sepsis blackswhites Sex – sepsis meningitis more common in males, esp. gram negative infections Birth asphyxia, meconium staining, stress Breaks in skin mucous membrane integrity (e.g. omphalocoele, meningomyelocoele) Environmental exposure Procedures (e.g. lines, ET-tubes) Predisposing Factors Maternal/Obstetrical Factors General – socioeconomic status, poor prenatal care, vaginal flora, maternal substance abuse, known exposures, prematurity, twins Maternal infections –chorioamnionitis (1-10% of pregnancies), fever (38° C/100.4° F), sustained fetal tachycardia, venereal diseases, UTI/bacteriuria, foul smelling lochia, GBS+, other infections Obstetrical manipulation – amniocentesis, amnioinfusion, prolonged labor, fetal monitoring, digital exams, previa/abruption? Premature Prolonged ROM, preterm labor Predisposing Factors Overall sepsis rate 8/1000 Maternal Fever 4/1000 PROM 10-13/1000 Fever PROM 87/1000 Preterm Labor/PROM Prematurity (~10%) 15-25% due to maternal infection 18-24h term; 12-18h preterm Bacterial infection ? synthesis of PG Macrophage TNF/IL stimulate PG synthesis, cytokine release** Release of collagenase elastase ? ROM + Amniotic fluid cultures 15% (with intact membranes) SEPSIS ORGANISMS Group B strep (most common G+) Coliforms (E. coli most common G-) Listeria Nosocomial infections Staph epidermidis Candida Note: 50% G+ and 50% G- Routes of Infection Transplacental/Hemato