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
- Sepsis
No other HR characteristic was associated with sepsis. The decrease in 0.1 units of approximate entropy was associated with an over 2-fold increase in the odds of sepsis. [ncbi.nlm.nih.gov]
Identification of extremely premature infants at low risk for early-onset sepsis [published online October 5, 2017]. Pediatrics. doi: 10.1542/peds.2017-0925 Topics: Antibiotic Stewardship Pediatrics Sepsis Next post in Sepsis [infectiousdiseaseadvisor.com]
- Poor Feeding
Respiratory distress and poor feeding were the most common signs reported in various studies (2, 14). It is presumed that there is an association between poor feeding and jaundice as common presentations of LOS. [pedinfect.com]
The earliest signs may be apnea, respiratory distress or poor feeding. Other signs and symptoms include lethargy, temperature instability, hyperbilirubinemia, bradycardia, seizures and acidosis. [uichildrens.org]
Eight days after she was born, the baby girl was admitted to a London, Ont. hospital with fever, poor feeding and fussiness. That same day, she was moved to the intensive care unit with multi-organ failure due to sepsis. [ctvnews.ca]
Infants may manifest neonatal sepsis by subtle signs such as poor feeding, jaundice, unusual rashes, or more obvious indicators such as seizures, projectile vomiting, or abdominal distention. [medicinenet.com]
- Congestive Heart Failure
heart failure and pulmonary edema (PDA, coarctation, etc.), or from shunting (cyanotic heart disease) Pulmonary - Impairment of oxygenation and ventilation from lung disease (surfactant deficiency disease, pneumonia, transient tachypnea of the newborn [uichildrens.org]
heart failure, and atrial septal defect. e) Nephrotic syndrome, glomerulonephritis, chronic renal failure, renal stone, renal cell carcinomas, hydronephrosis, single kidney, and acute pyelonephritis. f) Gastroesophageal reflux disease, hepatitis, liver [jsms.sch.ac.kr]
- Malaise
Maternal signs/symptoms may range from vague and mild malaise or myalgias to frank systemic illness with fever and chills and accompanying bacteremia. [cmr.asm.org]
Respiratoric
- Tachypnea
Intravenous fluids should be given when infants are not being fed enterally, such as those with tachypnea greater than 60 breaths per minute. [aafp.org]
RDS, respiratory distress syndrome; HMD, hyaline membrane disease, MAS, meconium aspiration syndrome; TTN, transient tachypnea of newborn. [jsms.sch.ac.kr]
[…] oxygenation from congestive heart failure and pulmonary edema (PDA, coarctation, etc.), or from shunting (cyanotic heart disease) Pulmonary - Impairment of oxygenation and ventilation from lung disease (surfactant deficiency disease, pneumonia, transient tachypnea [uichildrens.org]
In both term and preterm infants, early warning signs and symptoms are often minimal, subtle, nonspecific and can be easily misinterpreted as being due to transient tachypnea of the newborn, apnea of prematurity, bronchopulmonary dysplasia and environment [pjms.com.pk]
Also, infants with tachypnea and respiratory distress cannot maintain a coordinated suck and swallow. Renal insufficiency may require adjustments in fluid and electrolyte administration. [cancertherapyadvisor.com]
Gastrointestinal
- Abdominal Distension
We used TSS because it included both laboratory parameters, such as leukocyte and thrombocyte counts, CRP, and immature/total neutrophil ratio, and clinical parameters, such as skin color, body temperature, muscle tone, breath rate, abdominal distension [degruyter.com]
Gastrointestinal (GIT) symptoms poor feeding vomiting abdominal distension feed intolerance bilious aspirates/vomits loose stools. Central nervous system (CNS) symptoms lethargy irritability seizures. [bettersafercare.vic.gov.au]
[…] difficulties (respiratory rate of more than 60 breaths per minute, nasal flaring, grunting, or retractions)* Significant neurologic depression Abdominal distension No stool by 24 hours of age Signs of severe sepsis Infants who exhibit a difficulty in [aafp.org]
Others were abdominal distension, lethargy, jaundice, and bradycardia in single case each. [atmph.org]
Temperature instability, apnea, need for supplemented oxygen, need for ventilation, tachycardia/bradycardia, hypotension, feeding intolerance, abdominal distension, necrotizing enterocolitis were considered among clinical signs of sepsis. [nature.com]
- Projectile Vomiting
Infants may manifest neonatal sepsis by subtle signs such as poor feeding, jaundice, unusual rashes, or more obvious indicators such as seizures, projectile vomiting, or abdominal distention. [medicinenet.com]
Cardiovascular
- Hypertension
Lauterbach R (1993) Pentoxifylline treatment of persistent pulmonary hypertension of newborn. Eur J Pediatr 152 5:460 Google Scholar 3. [link.springer.com]
A toxin derived from the polysaccharide capsule of type III Streptococcus has also been shown to cause pulmonary hypertension. [emedicine.medscape.com]
[…] actue gastroenteritis, hernia, ulcerative colitis, gall bladder stone, and appendicitis. g) Immune thrombocytopenic purpura, anemia, pancytopenia, pituitary tumor, thyroid cancer, and breast cancer. h) Asthma, idiopathic pulmonary fibrosis, pulmonary hypertension [jsms.sch.ac.kr]
Decreased neutrophil production Maternal and pre-natal conditions-maternal hypertension, pre-eclampsia, pregnancy-induced hypertension, intrauterine growth restriction Donors of twin-twin transfusions Infants with Rh hemolytic disease Chronic neutropenia [fortunejournals.com]
Epinephrine adverse effects include increased PVR leading to reduced cardiac output and tissue perfusion, hypertension, tachycardia, and necrosis due to peripheral vessels leakage. [scielo.br]
Skin
- Skin Rash
Skin rashes like petechial and purpuric lesions are pathogenic for meningococcemia. Pseudomonas aeruginosa has specific skin lesions called the Bull’s eye lesions. DIC may also occur with purpura and hemorrhage from blood sampling sites. [ijp.iranpath.org]
While the presence of a rash (especially vesicular) should always lead to the consideration of neonatal herpes in differential diagnoses, a significant minority will not have a rash, and the systemic signs may precede skin lesions (196). [cmr.asm.org]
Neurologic
- Intracranial Hemorrhage
intracranial hemorrhage, neonatal seizures, perinatal asphyxia, or other pathology which could lead to increased intracranial pressure Cardiovascular - Impairment of oxygenation from congestive heart failure and pulmonary edema (PDA, coarctation, etc [uichildrens.org]
[…] mortality. (59) Volume replacement causes hemodilution, specially in anemic newborns or intracranial hemorrhage prematures. [scielo.br]
[…] perforation (SIP), severe intracranial hemorrhage (ICH) grade 3 or 418 based on a cranial sonogram taken within 28 days of birth, periventricular leukomalacia (PVL), and bronchopulmonary dysplasia (BPD) defined as need for supplemental oxygen at 36 weeks [pediatrics.aappublications.org]
hemorrhage,[ 57 ] and the need for several different cut-off values with changing neonatal age, have limited its diffusion as an early marker in comparison to CRP. [intechopen.com]
- Stroke
Meningitis can cause fluid build-up in the brain (edema), increased pressure in the brain (increased intracranial pressure), brain abscesses (pus-filled pockets), hydrocephalus, cerebral infarction, and stroke. [abclawcenters.com]
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]
Microbiology
- Blood Culture Positive
Results: In the non-infected group, 5/21 infants had a positive PCR result with coagulase-negative staphylococci. All pathogens detected in the blood culture positive group (n = 15) were also detected by PCR. [karger.com]
The primary outcomes were necrotising enterocolitis (Bell stage 2 or 3), blood culture positive sepsis more than 72 h after birth; and death before discharge from hospital. All primary analyses were by intention to treat. [discover.dc.nihr.ac.uk]
All blood cultures throughout hospitalization were reviewed, and the patients of the non-septic group had negative blood cultures. [scielo.br]
Males showed higher blood culture positivity (33 of 57 cases, 57.9%) than females (24 of 57 cases, 42.1%), which is comparable with other studies. [5], [6] The significant high incidence of culture-proven sepsis among neonates with extreme prematurity [jcnonweb.com]
- Chlamydia
Some of these include HIV, gonorrhea, syphilis, herpes, Chlamydia, and hepatitis B, as well as immunity to rubella and chickenpox. Between the 35th and 37th week of pregnancy, screening for group B strep is commonly performed. [medicinenet.com]
Additional organisms, such as coagulase-negative Staphylococcus epidermidis, L monocytogenes, Chlamydia pneumoniae, H influenzae, Enterobacter aerogenes, and species of Bacteroides and Clostridium have also been identified in neonatal sepsis. [emedicine.medscape.com]
Some of the commonly identified pathogens include Ureaplasma urealyticum, Chlamydia trachomatis, Neisseria gonorrea, Mycoplasma hominis, group B strephtococcus and Trichomonas vaginalis. [elsevier.es]
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]