Neonatal sepsis early detection and antibiotics choice课件.ppt

Neonatal Sepsis and Recent Challenges Mohammad Khasswneh, MD Assistant Professor of Pediatrics JUST introduction Common 20% of VLBW has sepsis In term 0.1% Inter-institution difference 11-32% (NICHD net work) Serious mortality is 3-5 times more for infant with sepsis in NICU Classification Early onset sepsis (EOS): bacteria acquired before and during delivery 5-7/1000 live birth 1.5% of VLBW infants had EOS (intrapartum antibiotics) Late onset sepsis (LOS): bacteria acquired after delivery (Nosocomial or community) 20% of VLBW infants Who is the septic neonate? Positive blood culture with clinical symptoms of infection Coagulase-negative Staphylococcus (CoNS) 2 positive blood cultures One positive blood culture and elevated CRP Clinical sepsis” or “probable sepsis Adult and PediatricsDefinitions Systemic Inflammatory response syndrome (SIRS) Sepsis as SIRS plus infection Severe sepsis: as sepsis associated with organ dysfunction, hypo perfusion or hypotension, Septic shock sepsis with arterial hypotension despite fluid resuscitation Blood Culture One out of five evaluations for sepsis has positive blood culture 80% of the time, empiric antibiotics will be given when no organism is isolated from culture Blood culture In a 1999, autopsy study of ELBW infants infection was primary cause of death by pathologists in (56 of 111) sepsis was not diagnosed prior to death for 61% of these 56 neonates False negative Blood Culture Maternal antibiotics Small blood sample in a prospective study of nearly 300 blood cultures drawn from critically ill neonates, 55% of culture vials contained less than 0.5 ml of blood Bacteria load, timing of sampling Clinical Signs according to WHO Integrated Management of Childhood illness Respiratory rate 60 breaths/min Retraction, flaring, Grunting Crepitation Cyanosis Clinical Sings according to WHO Integrated Management of Childhood illness Temperature 37.7°C (or feels hot) or 35.5°C (or feels cold) Convulsions ,Letharg