新生儿败血症课件_24.pptVIP

case1 Patient1: 25.10.04 Sex: female GA:35+6W BW:2770g Vaginal delivery with vacuum Apgar:7-7-8 NS-pH:7.22 Obstetric factors PROM of 2days intrapartum ampicillin because of PROM and maternal elevation of CRP Admitted to NICU duo to tachypnea General condition is stable Infection blood culture(25.10.04 ): E.coli WBC CRP Antibiotics: 25.10.04---31.10.04 Case 2 Patient: 15.10.04 + 16.10.04 Gestational week: 30 2/7 Birth weight: 1 490 g Apgar: 5-6-8 pH: 7,38 Postnatal poor adaption, transport with CPAP, FiO2 0,5, SaO2 92% Obstetric factors Premature and prolonged rupture of membranes Therapy with Ampicillin Lung maturation was given Therapy Infection should be the first thought when an infant has symptoms Aggressive treatment should begin before the diagnosis is confirmed. Therapy can be discontinued if sepsis is excluded Dosages of antibiotics for newborns Supporting therapy Nursing care --warm environment --oxygen supply correction of acidosis and electrolyte disturbance fluid , glucose and nutrition balance Management of complications Shock DIC Cerebral edema Pulmonary hemorrhage Immunotherapy IVIG Exchange transfusion Granulocyte transfusion，G-CSF Platelet transfusion Questions Could prophylatic IVIG reduce the morbidity and mortality of neonatal sepsis? Might prophylatic IVIG interfere the development of the neonatal IM system? * Immune system Neutrophils – Qualitative and quantitative Complement and immunoglobulin levels decreased T cells- antigenically na?ve limited cytokine production Why are newborns so vulnerable to infection? Poor skin barrier Umbilical stump Poor blood-brain barrier 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 Clinical manifestations EOS LOS Onset Within 7 days 7