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Mortality Rate (%) 95% Confidence Interval Range*
*Intra units (5 or more cases) Data from Valls-e-Soker A, et al. 2009 (5)
Early-onset Sepsis
3.6 3:4.1 0 to 10.5
NNF, India
Neonatal Sepsis- Definitions
Culture positive sepsis --Isolation of the pathogen from blood, CSF, urine or abscess <72 hours of age
Pathological evidence of sepsis on autopsy
NNF, India
Neonatal Sepsis- Incidence
Incidence of EOS is 1-2 cases/1000 live births. This incidence is 10 fold higher in the VLBW infants. Incidence of early onset GBS has declined 80% from
26.4 19.1:33.7 20 to 57.1
Late-onset Sepsis
25.0 23.6:26.3 0 to 53.7
13.3 11.2:15.4 1.8 to 35.6
NeoReviews, Vol.11, No.8, August 2019
Neonatal Sepsis
Septicemia Pneumonia Meningitis Arthritis Osteomyelitis Urinary tract infection
Aggarwal et al. India j Pediatr. 2019;68:1143-7
Neonatal Sepsis- Classification
Late onset sepsis (>72 hours) usually nosocomial or community acquired) Risk factors: – NICU admission – Poor hygiene – Low birth weight – Poor cord care – Prematurity – Bottle feeding – Invasive procedure – Superficial infection (pyoderma, umbilical sepsis) – Ventilation – Aspiration of feeds
Antibiotic Prophylaxis
Puopolo, K., NeoReviews 2019, 9;571-e579
Risk Factors for Early-onset GBS Sepsis in the Absence of IAP
Puopolo, K., NeoReviews 2019, 9;571-e579
Temperature
Skin
irregularity
– Poor perfusion
– Fever
– Cyanosis
– Hypothermia
– Mottling
Tone and Behavior
– Pallor
– Poor tone – Weak suck
– Petechiae – Unexplained jaundice
Puopolo KM. NeoReviews 2019;9:e571-579
Neonatal Sepsis- Classification
Early onset sepsis (<72 hours) Risk factors:
– Low birth weight – Febrile illness in the mother with in 2 weeks PTD – Fouls smelling amniotic fluid – PROM (>24 hours) – More than three vaginal exam during labor – Prolonged and difficult delivery with instrumentation – Perinatal asphyxia (apgar <4 at 1min) or difficult resuscitation – (presence of 3- treat, Presence of 2- sepsis screen)
Pneumococcus Meningococcus GABHS Haemophilus influenzae (HIB) not really a
problem anymore
Signs/Symptoms
Most by themselves mean little, but three (or two) strikes and you are Out!
PIDJ April found that any two of these signs had an almost 100% sensitivity for sepsis and over 90% mortality
Reduced sucking Weak cry Cool extremities Vomiting Poor tone Retractions
Incidence of systemic infection is 3% (India) with septicemia (75%) and pneumonia (25%)
NNP Network, 2019
Early– and Late-onset Sepsis
Infection Rate (%) 95% Confidence Interval Range*
E. coli
– Every few decades flips back and forth with GBS as most common cause
Gram negative rods (esp. in urine)
– Occasional Salmonella sepsis
Listeria monocytogenes Herpes Simplex Enterovirus
“Early” Pathogens (first week)
Group B Strep (GBS)
– Incidence used to be 4-6/1000 live births (0.4%) – Now <0.1% after prenatal screening guidelines
1.7 cases /1000 live births (1993) to 0.34/1000 live births (2019) due to intrapartum antibiotic prophylaxis. Mortality 2.6% in term and 35% in VLBW infants. Survivors of EOS may have severe neurologic sequelae attributable to meningitis, hypoxemia, septic shock, PPHN etc.
Neonatal Sepsis-Investigations
Blood culture (1ml sample adequate) possible to detect growth in 24 hours using BACTEC
or BACT/ALERT systems Total WBC count (<5000/mm) Band/ Neutrophil ratio >0.2 CRP >1mg/dl or Micro- ESR >15mm/hr LP (incidence of meningitis 0.3-3%) In EOS LP is indicated in the presence of + blood
Sankar et al. Indian j Pediatr.2019;75:261-6
Neonatal Sepsis- Definitions
Probable sepsis (any one criteria): -Maternal fever or foul smelling amniotic fluid -PROM (> 24 hrs) or gastric polymorphs (>5 hpf) -Positive sepsis screen (any two criteria) -Total WBC count (<5000/mm or band/neutrophil ratio >0.2) -Total WBC count <1800/mm -C-reactive protein (CRP) >1mg/dl, micro ESR >10 mm-first hour -Radiological evidence of pneumonia
新生儿脓毒症
Neonatal Sepsis
Most common cause of neonatal mortality in developing countries.
Up to 20% of neonates develop sepsis and 1% die of sepsis related causes.
“Late” Pathogens (~1-2 weeks)
GBS or group A strep Enterics/Enterococcus in urine HSV Enterovirus, RSV, Flu
Community Acquired (after 4-6 weeks)
Organisms Causing Neonatal Early-onset Sepsis
Puopolo, K., NeoReviews 2019, 9;571-e579
Organisms Causing Early-onset Sepsis in Very Low-birthweight Infants
– Tachypnea – Retractions – Tachycardia for age – Bradycardia in first
few days of life – Hypotension for age – Low PO2
Signs/Symptoms
Sunken fontanelle Bulging or pulsating fontanelle Neck stiffness CAN NOT be used Babies can be bacteremic but look well Presence of a “cold” does not change anything
– Shrill cry
– Weak cry
– Irritability
Signs/Symptoms
Feeding Problems
– Vomiting
– Diarrhea
– Abdominal distension
– Hypo or Hyperglycemia
Cardiopulmonary
Puopolo, K., NeoReviews 2019, 9;571-e579
Risk Factors for All Causes of Early-onset Sepsis in Infants Weighing Less than 2000 g at Birth in the Era of Intrapartum
NNP Network, 2019
Neonatal Sepsis
Intramural admissions --Klebsiella pneumoniae (32.5%) --Staphylococcus aureus (13.6%)
Extramural admissions --Klebsiella (27.5%) --S aureus (38%)
*Intra units (5 or more cases) Data from Valls-e-Soker A, et al. 2009 (5)
Early-onset Sepsis
3.6 3:4.1 0 to 10.5
NNF, India
Neonatal Sepsis- Definitions
Culture positive sepsis --Isolation of the pathogen from blood, CSF, urine or abscess <72 hours of age
Pathological evidence of sepsis on autopsy
NNF, India
Neonatal Sepsis- Incidence
Incidence of EOS is 1-2 cases/1000 live births. This incidence is 10 fold higher in the VLBW infants. Incidence of early onset GBS has declined 80% from
26.4 19.1:33.7 20 to 57.1
Late-onset Sepsis
25.0 23.6:26.3 0 to 53.7
13.3 11.2:15.4 1.8 to 35.6
NeoReviews, Vol.11, No.8, August 2019
Neonatal Sepsis
Septicemia Pneumonia Meningitis Arthritis Osteomyelitis Urinary tract infection
Aggarwal et al. India j Pediatr. 2019;68:1143-7
Neonatal Sepsis- Classification
Late onset sepsis (>72 hours) usually nosocomial or community acquired) Risk factors: – NICU admission – Poor hygiene – Low birth weight – Poor cord care – Prematurity – Bottle feeding – Invasive procedure – Superficial infection (pyoderma, umbilical sepsis) – Ventilation – Aspiration of feeds
Antibiotic Prophylaxis
Puopolo, K., NeoReviews 2019, 9;571-e579
Risk Factors for Early-onset GBS Sepsis in the Absence of IAP
Puopolo, K., NeoReviews 2019, 9;571-e579
Temperature
Skin
irregularity
– Poor perfusion
– Fever
– Cyanosis
– Hypothermia
– Mottling
Tone and Behavior
– Pallor
– Poor tone – Weak suck
– Petechiae – Unexplained jaundice
Puopolo KM. NeoReviews 2019;9:e571-579
Neonatal Sepsis- Classification
Early onset sepsis (<72 hours) Risk factors:
– Low birth weight – Febrile illness in the mother with in 2 weeks PTD – Fouls smelling amniotic fluid – PROM (>24 hours) – More than three vaginal exam during labor – Prolonged and difficult delivery with instrumentation – Perinatal asphyxia (apgar <4 at 1min) or difficult resuscitation – (presence of 3- treat, Presence of 2- sepsis screen)
Pneumococcus Meningococcus GABHS Haemophilus influenzae (HIB) not really a
problem anymore
Signs/Symptoms
Most by themselves mean little, but three (or two) strikes and you are Out!
PIDJ April found that any two of these signs had an almost 100% sensitivity for sepsis and over 90% mortality
Reduced sucking Weak cry Cool extremities Vomiting Poor tone Retractions
Incidence of systemic infection is 3% (India) with septicemia (75%) and pneumonia (25%)
NNP Network, 2019
Early– and Late-onset Sepsis
Infection Rate (%) 95% Confidence Interval Range*
E. coli
– Every few decades flips back and forth with GBS as most common cause
Gram negative rods (esp. in urine)
– Occasional Salmonella sepsis
Listeria monocytogenes Herpes Simplex Enterovirus
“Early” Pathogens (first week)
Group B Strep (GBS)
– Incidence used to be 4-6/1000 live births (0.4%) – Now <0.1% after prenatal screening guidelines
1.7 cases /1000 live births (1993) to 0.34/1000 live births (2019) due to intrapartum antibiotic prophylaxis. Mortality 2.6% in term and 35% in VLBW infants. Survivors of EOS may have severe neurologic sequelae attributable to meningitis, hypoxemia, septic shock, PPHN etc.
Neonatal Sepsis-Investigations
Blood culture (1ml sample adequate) possible to detect growth in 24 hours using BACTEC
or BACT/ALERT systems Total WBC count (<5000/mm) Band/ Neutrophil ratio >0.2 CRP >1mg/dl or Micro- ESR >15mm/hr LP (incidence of meningitis 0.3-3%) In EOS LP is indicated in the presence of + blood
Sankar et al. Indian j Pediatr.2019;75:261-6
Neonatal Sepsis- Definitions
Probable sepsis (any one criteria): -Maternal fever or foul smelling amniotic fluid -PROM (> 24 hrs) or gastric polymorphs (>5 hpf) -Positive sepsis screen (any two criteria) -Total WBC count (<5000/mm or band/neutrophil ratio >0.2) -Total WBC count <1800/mm -C-reactive protein (CRP) >1mg/dl, micro ESR >10 mm-first hour -Radiological evidence of pneumonia
新生儿脓毒症
Neonatal Sepsis
Most common cause of neonatal mortality in developing countries.
Up to 20% of neonates develop sepsis and 1% die of sepsis related causes.
“Late” Pathogens (~1-2 weeks)
GBS or group A strep Enterics/Enterococcus in urine HSV Enterovirus, RSV, Flu
Community Acquired (after 4-6 weeks)
Organisms Causing Neonatal Early-onset Sepsis
Puopolo, K., NeoReviews 2019, 9;571-e579
Organisms Causing Early-onset Sepsis in Very Low-birthweight Infants
– Tachypnea – Retractions – Tachycardia for age – Bradycardia in first
few days of life – Hypotension for age – Low PO2
Signs/Symptoms
Sunken fontanelle Bulging or pulsating fontanelle Neck stiffness CAN NOT be used Babies can be bacteremic but look well Presence of a “cold” does not change anything
– Shrill cry
– Weak cry
– Irritability
Signs/Symptoms
Feeding Problems
– Vomiting
– Diarrhea
– Abdominal distension
– Hypo or Hyperglycemia
Cardiopulmonary
Puopolo, K., NeoReviews 2019, 9;571-e579
Risk Factors for All Causes of Early-onset Sepsis in Infants Weighing Less than 2000 g at Birth in the Era of Intrapartum
NNP Network, 2019
Neonatal Sepsis
Intramural admissions --Klebsiella pneumoniae (32.5%) --Staphylococcus aureus (13.6%)
Extramural admissions --Klebsiella (27.5%) --S aureus (38%)