Presentation
The authors present the case of extremely preterm twins who both developed life-threatening coliform sepsis in second postnatal week within a short time period of each other. Methods Case report. [adc.bmj.com]
This abnormal HR behavior may help to monitor premature infants presenting with frequent and severe bradycardias. Copyright 2009 S. Karger AG, Basel. [ncbi.nlm.nih.gov]
Late-onset sepsis was present in 94 preterm infants with VLBW, an incidence of 22.8%. [scielo.br]
Meningitis may also be present but is not common. In late-onset GBS infection (at > 3 days to 12 wk), meningitis is often present. [msdmanuals.com]
Entire Body System
- Asymptomatic
Management of asymptomatic, term gestation neonates born to mothers treated with intrapartum antibiotics. Pediatr Infect Dis J 1990;9:826-831. 9. Teji JS, Srinivasan G, et al. Management of asymptomatic neonates with prolonged rupture of membranes. [hawaii.edu]
The LP can be deferred for asymptomatic infants. [cps.ca]
Reliance solely on enhanced clinical surveillance for infection in an asymptomatic twin may be insufficient. [adc.bmj.com]
Maternal infection that is the source of transplacental fetal infection is often undiagnosed during pregnancy because the mother was either asymptomatic or had nonspecific signs and symptoms at the time of acute infection. 6. [slideshare.net]
Hypoglycemia can be asymptomatic in large-for-gestational-age infants and infants of mothers who have diabetes. A hyperoxia test can be used to differentiate between pulmonary and cardiac causes of hypoxemia. [aafp.org]
- Hypoxemia
Cardiopulmonary response to sepsis In overwhelming sepsis, there may be an initial early phase characterized by pulmonary hypertension, decreased cardiac output, and hypoxemia. [emedicine.medscape.com]
Patients should be evaluated for hypoxemia and for signs of pulmonary hypertension. Fluid administration Feeding intolerance is common. Also, infants with tachypnea and respiratory distress cannot maintain a coordinated suck and swallow. [cancertherapyadvisor.com]
A hyperoxia test can be used to differentiate between pulmonary and cardiac causes of hypoxemia. [aafp.org]
Chronic hypoxemia absent bacterial infection is one cause of the fetal inflammatory response syndrome (FIRS). Reprod Sci. 2009;16(7):650-6. [ Links ] 12. Silveira RC, Procianoy RS. [scielo.br]
Furthermore, it can be falsely elevated in other noninfective conditions such as intracranial hemorrhage, birth asphyxia, and conditions associated with neonatal hypoxemia. 61 – 64 Used in conjunction with CRP, a positive PCT level (≥2.5 ng/mL) increased [dovepress.com]
- Feeding Difficulties
Side Effects - Barotrauma, nasal irritation, abdominal distention and feeding intolerance. Feeding difficulties can be minimized by switching the patient to continuous drip feeds. [uichildrens.org]
Clinical findings included hypo and hypertermia, apnoea, bradycardia and tachycardia, circulatory disorders, hypotonia, feeding difficulty and lethargy. [signavitae.com]
Individual attributes (e.g., hypoglycemia, oral feeding difficulties, and seizures) fail to capture the overall neonatal health and morbidity status. [clinchem.aaccjnls.org]
- Developmental Disorder
In cases of intraventricular hemorrhage, the diagnosis was performed using cranial ultrasound, and only cases with grade 3 and 4 on the Papile classification were considered for statistical analysis, due to their association with developmental disorders [scielo.br]
- Pathologist
In 1993, the College of American Pathologists surveyed 6600 hematology technicians in a band neutrophil identification exercise ( 82 ). [clinchem.aaccjnls.org]
Skin
- Urticaria
For parturients with a history of serious penicillin allergy (anaphylaxis, angioedema, respiratory compromise, or urticaria), clindamycin is an acceptable alternative agent, but only if the woman’s rectovaginal GBS screening isolate has been tested and [pediatrics.aappublications.org]
§, penicillin-allergic patients with a history of anaphylaxis, angioedema, respiratory distress, or urticaria following administration of penicillin or a cephalosporin are considered to be at high risk for anaphylaxis and should not receive penicillin [cmr.asm.org]
Neurologic
- Neonatal Seizures
Rapid IV pushes have been associated with SUDDEN DEATH from CARDIAC ARRHYTHMIAS Major side effects - tachycardia, vomiting, feeding intolerance, jitteriness and seizures. [uichildrens.org]
Workup
Blood samples for bone turnover markers were collected during the initial sepsis workup, and at the end of the first week of treatment, and were compared to the corresponding weekly changes in bone markers in the controls. [ncbi.nlm.nih.gov]
A sepsis workup may be needed to help identify the location of the infection and type of microorganism causing the infection. A sepsis workup may include the following procedures: Blood tests Lumbar puncture (also called spinal tap). [stanfordchildrens.org]
Infants showing no signs of neonatal sepsis will have a sepsis workup done only if concerning factors are shown. Only a small percentage of infants will have a sepsis workup done. [en.wikipedia.org]
Serum
- Neutropenia
Granulocyte transfusions for neonates with confirmed or suspected sepsis and neutropenia More evidence is needed on the effects of granulocyte infusions for babies with sepsis and neutropenia (decreased number of white blood cells). [cochranelibrary.com]
The ANC of <1500 cells/mm3 is considered neutropenia, which could be congenital or acquired. [ncbi.nlm.nih.gov]
INTERPRETATION:Early postnatal prophylactic GM-CSF corrects neutropenia but does not reduce sepsis or improve survival and short-term outcomes in extremely preterm neonates. [paper.medlive.cn]
Non-specific: • White blood cell count and differential: Neutropenia can be a threatening sign (< 1,800/cmm). Immature to Total neutrophil (I:T) ratio ≥ 0.2 is predictive (Normal: ˂ 0.16). • Acute phase reactants: C-Reactive Protein (CRP): rises [slideshare.net]
- Hypoglycemia
Hypoglycemia. Hypoglycemia, or low blood sugar, is usually seen in premature infants, infants born to a mom with gestational diabetes or infants who have an infection. Perinatal depression. [unitypoint.org]
Hypoglycemia Hypoglycemia, defined as a whole-blood glucose level of less than 45 mg per dL (2.50 mmol per L), can occur in infants who are small-or large-for-gestational-age, or premature, and in those who have low glycogen stores, hyperinsulinemia, [aafp.org]
Hypoglycemia / hyperglycemia 7. Hypotension 8. Jaundice What other disease/condition shares some of these symptoms? Clinical signs and symptoms of septicemia are non-specific and overlap with findings in other diseases. [cancertherapyadvisor.com]
These can include: brain hemorrhage, or bleeding in the brain pulmonary hemorrhage, or bleeding in the lungs hypoglycemia, or low blood sugar neonatal sepsis, a bacterial blood infection pneumonia, an infection and inflammation of the lungs patent ductus [healthline.com]
Metabolic - Hypocalcemia, hypoglycemia, hyponatremia or acidosis Hematological - Anemia Gastrointestinal - NEC or gastroesophageal reflux Temperature Regulation - Hypothermia or hyperthermia Drugs - Prenatal exposure with transplacental transfer to the [uichildrens.org]
- Neutrophilia
A complete blood count showed an increased leukocyte count 33.4 × 10 9 /L and neutrophilia, normal hemoglobin, red cell count, and platelets. ABO incompatibility was excluded. [clinchem.aaccjnls.org]
Neutropenia is more predictive of neonatal sepsis than neutrophilia, but it may be present in maternal hypertension, birth asphyxia and periventricular hemorrhage. [biochemia-medica.com]
A clinical examination revealed an erythrocyte sedimentation rate of 30 mm in the first hour (normal 9 range 1–12 mm), white blood cells count of 14.5 10 /L 9 9 (3.4–9.7 10 /L) with neutrophilia 11.7 10 /L (2.1–6.5 9 10 /L) and raised levels of urea 10.2 [studyres.com]
When newborn animals are inoculated with a non‐lethal dose of bacteria, neutrophilia occurs after a latent period of three to five hours associated with a reduction in bone marrow storage pool of neutrophils ( al‐Mulla 1995 ). [cochranelibrary.com]
Evaluation of Neutropenia and Neutrophilia in Preterm Infants. J Matern Fetal Neonatal Med 25 (2012): 100-103. Sandberg K, Fasth A, Berger A, et al. [fortunejournals.com]
Treatment
In some units, 48-hourly LPs are performed in cases of Gram-negative meningitis, with treatment continuing for 14 days after the first negative culture - in practice this usually equates with a 21-day treatment course. [bettersafercare.vic.gov.au]
Viral infections Intravenous fluids Oxygen Treating the source of infection Increasing blood pressure Other treatments Emergency treatment You'll need emergency hospital treatment and may require admission to an intensive care unit (ICU) if: the sepsis [nhsinform.scot]
What about long-term treatment? Typically, treatment is confined to the hospitalization. Long-term treatment would be necessary for infants who develop complications secondary to the infection. [cancertherapyadvisor.com]
[…] an alternative method of treatment. • If meningitis is present, the treatment should be extended to 21 days or 14 days after a negative result from a CSF culture. 12. • 2. [slideshare.net]
In addition, using different culture media and repeating the examinations when necessary or analyzing the cerebral fluid in case of treatment failure may improve diagnosis and treatment probability. [ijp.iranpath.org]
Prognosis
Prognosis and Treatment Sepsis in a newborn is treated with antibiotics given intravenously. Treatment is started even before laboratory results are available; a different antibiotic may later be chosen based on the results of laboratory tests. [hon.ch]
Prognosis and Treatment Sepsis in a newborn is treated with antibiotics given intravenously. Antibiotics are often started even before laboratory and culture results are available. [rchsd.org]
What is the prognosis? In cases of untreated neonatal sepsis, the mortality can be as high as 50 to 100%. [jfhc.co.uk]
This study did not carry out either any long-term monitoring of infants with sepsis to assess the prognosis of this infection. [degruyter.com]
At the lowest gestational ages, a large proportion of deaths with the poorest survival prognosis. [omicsonline.org]
Etiology
ETIOLOGY • Common organisms identified: • 1. Escherichia coli. • 2. Group B Streptococci. • 3. [slideshare.net]
Keywords Child, Preschool — Cohort Studies — Developmental Disabilities/epidemiology/etiology/microbiology — Female — Follow-Up Studies — Humans — Infant — Infant, Extremely Low Birth Weight — Infant, Newborn — Infant, Premature — Infant, Premature, Diseases [archive-ouverte.unige.ch]
For patients in the observed group infectious etiology was Introduction White dot syndrome comprises a heterogeneous group of autoimmune diseases of a noninfectious etiology that affect the choriocapillaris, pigment epithelium and the exterior layers [yumpu.com]
Abstract The epidemiology, etiology and outcome of neonatal sepsis are changing over time. [nature.com]
An infectious etiology, immunological derangements, and vascular disorders have been studied in order to find the connection with this condition. [studyres.com]
Epidemiology
/epidemiology/microbiology — Male — Prospective Studies — Risk Factors — Sepsis/complications/epidemiology — Sickness Impact Profile — Switzerland/epidemiology — Treatment Outcome Identifiers DOI: 10.1542/peds.2010-3338 PMID: 21768312 Full text Article [archive-ouverte.unige.ch]
The 4th edition includes an entirely new section on pediatric obesity: epidemiology, pathophysiology, assessment and treatment. It includes new chapters on celiac disease, food allergies and iron. [books.google.com]
An up-to-date and thorough understanding of the epidemiology and management of neonatal LOS may help to reduce the burden of this disease. [fn.bmj.com]
We now need to have more studies and more tools; specially molecular tools to study the epidemiology of this emerging pathogen. [atmph.org]
An epidemiological survey of neonatal sepsis in a hospital in Western Nigeria. African Journal of Microbiology Research. 2009;3:385-9. 8. Rohsiswatmo R.K ontroversi diagnosis sepsis neonatorum. In: Hegar B, Trihono Pp, Ifran EB, editors. [paediatricaindonesiana.org]
Pathophysiology
Among the pediatric texts available, none deals with the physiologic or pathophysiologic basis of nutrition in pediatric health and disease in children of all ages. [books.google.com]
Biophysics (644) Physiology and Pathophysiology (83) Medical Chemistry and Biochemistry (66) Paediatrics, Neonatology (62) Neurology (38) Otorhinolaryngology (32) Radiology and Imaging (32) Internal Medicine (31) Nuclear Medicine (29) Ophthalmology and [portal.mefanet.cz]
Neonatology: Pathophysiology and Management of the Newborn. 3rd ed., Philadelphia: JB Lippincott, 1987: 483-484. Martin RJ, Miller MJ, Carlo WA. Pathogenesis of apnea in preterm infants. J Pediatr 1986;109:733-741. Rall TW. [uichildrens.org]
Pathophysiology: the role of the mediators and bacterial agent Several proinflammatory cytokines are produced and secreted because of the bacterial agent in the blood stream. [scielo.br]
Overgrowth of these organisms in the neonatal lumen can be a component of the multifactorial pathophysiology of necrotizing enterocolitis. [emedicine.medscape.com]
Prevention
Methods studied to prevent late-onset sepsis include early feedings, immune globulin administration, prophylactic antimicrobial administration, and improved hand hygiene. [ncbi.nlm.nih.gov]
What methods of prevention are available? At the time of designation, several antibiotics were used to treat and to prevent sepsis in premature babies. [fdocuments.in]
[…] remains to be the cornerstone of LOS prevention. [fn.bmj.com]
Centers for Disease Control and Prevention. Prevention of perinatal group B streptococcal disease: a public health perspective. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1996 May 31. 45 (RR-7):1-24. [Medline]. [emedicine.medscape.com]