Sepsis新生儿败血症课件.ppt

Neonatal Sepsis Kirsten E. Crowley, MD June, 2005 Definition Incidence Clinical syndrome of systemic illness accompanied by bacteremia occurring in the first month of life Incidence 1-8/1000 live births 13-27/1000 live births for infants 1500g Mortality rate is 13-25% Higher rates in premature infants and those with early fulminant disease Early Onset First 5-7 days of life Usually multisystem fulminant illness with prominent respiratory symptoms (probably due to aspiration of infected amniotic fluid) High mortality rate 5-20% Typically acquired during intrapartum period from maternal genital tract Associated with maternal chorioamnionitis Late Onset May occur as early as 5 days but is most common after the first week of life Less association with obstetric complications Usually have an identifiable focus Most often meningitis or sepsis Acquired from maternal genital tract or human contact Nosocomial sepsis Occurs in high-risk newborns Pathogenesis is related to the underlying illness of the infant the flora in the NICU environment invasive monitoring Breaks in the barrier function of the skin and intestine allow for opportunistic infection Causative organisms Primary sepsis Group B streptococcus Gram-negative enterics (esp. E. coli) Listeria monocytogenes, Staphylococcus, other streptococci (entercocci), anaerobes, H. flu Nosocomial sepsis Varies by nursery Staphylococcus epidermidis, Pseudomonas, Klebsiella, Serratia, Proteus, and yeast are most common Risk factors Prematurity and low birth weight Premature and prolonged rupture of membranes Maternal peripartum fever Amniotic fluid problems (i.e. mec, chorio) Resuscitation at birth, fetal distress Multiple gestation Invasive procedures Galactosemia Other factors: sex, race, variations in immune function, hand washing in the NICU Clinical presentation Clinical signs and symptoms are nonspecific Differential diagnosis RDS Metabolic disease Hematologic disease CNS disease Cardiac disease Other infectious proce