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1、NeonatalSepsisandRecentChallengesMohammadKhasswneh,MDAssistantProfessorofPediatricsJUSTintroductionCommon20%ofVLBWhassepsisInterm0.1%Inter-institutiondifference11-32%(NICHDnetwork)Seriousmortalityis3-5timesmoreforinfantwithsepsisinNICUClassificationEarlyonsetsepsis(EOS):bacteriaacquiredbeforea
2、ndduringdelivery5-7/1000livebirth1.5%ofVLBWinfantshadEOS(intrapartumantibiotics)Lateonsetsepsis(LOS):bacteriaacquiredafterdelivery(Nosocomialorcommunity)20%ofVLBWinfantsWhoisthesepticneonate?PositivebloodculturewithclinicalsymptomsofinfectionCoagulase-negativeStaphylococcus(CoNS)2positiveblood
3、culturesOnepositivebloodcultureandelevatedCRPClinicalsepsis”or“probablesepsisAdultandPediatrics DefinitionsSystemicInflammatoryresponsesyndrome(SIRS)SepsisasSIRSplusinfectionSeveresepsis:assepsisassociatedwithorgandysfunction,hypoperfusionorhypotension,Septicshocksepsiswitharterialhypotensiond
4、espitefluidresuscitationBloodCultureOneoutoffiveevaluationsforsepsishaspositivebloodculture80%ofthetime,empiricantibioticswillbegivenwhennoorganismisisolatedfromcultureBloodcultureIna1999,autopsystudyofELBWinfantsinfectionwasprimarycauseofdeathbypathologistsin(56of111)sepsiswasnotdiagnosedprio
5、rtodeathfor61%ofthese56neonatesFalsenegativeBloodCultureMaternalantibioticsSmallbloodsampleinaprospectivestudyofnearly300bloodculturesdrawnfromcriticallyillneonates,55%ofculturevialscontainedlessthan0.5mlofbloodBacteriaload,timingofsamplingDiagnosisClinicalSigns accordingtoWHOIntegratedManagem
6、entofChildhoodillnessRespiratoryrate>60breaths/minRetraction,flaring,GruntingCrepitationCyanosisClinicalSings accordingtoWHOIntegratedManagementofChildhoodillnessTemperature>37.7°C(orfeelshot)or<35.5°C(orfeelscold)Convulsions,LethargicorunconsciousReducedmovementsandactivity)Notabletofeed(sust
7、ainsuck)BulgingfontanelsOthersignsinNICUabnormalheartratecharacteristicsReduceddigitalcapillaryrefilltimemetabolicacidosisIncreaseinweightClinicalsignsofsepsis inVLBWinfantsNICHDnetworkstudyApneain55%gastrointestinalproblems(46%),increa
