1Dr vakili amini

History Prenatal :maternal,fetus Perinatal and birth time postnatal 2

Is the neonate ill or not? AFTABP : -Activity -Feeding -Tonicity -Awareness -Breathing -Perfusion 3

Sepsis in neonate Systemic or local (lung, cutaneous, ocular, umbilical, kidney,bone-joint,meningeal) early onset or late onset(nosocomial or community acquired) 4

Acquired in utero : - transplacental (syphilis,LMC) - transcervical (ascending) Acquired during or after birth 5

6 transcervical (ascending) infections With or without ROM : - amnionitis - funistitis (corditis) - congenital pneumonia - sepsis Common bacterial are organism of maternal urinary- genitalial tract : GBS,Ecoli,Hinflu,klebsiella Viral : HSV-1,HSV-2(more) : also causes ascending infection (indistinguishable from bacterial sepsis) Syphilis and LMC : acquired transplacental infection

7 Sepsis : 1/1500 in fullterm 1/250 (x6) in preterm 1/20 of sepsis with meningitis Organism : - GBS,Ecoli,LMC (common) -Klebsiella,Serratia marcescens ( less development countries) -CONS (in VLBW) Male infants more susceptible to neonatal infection con’t

8 In nICU : hostile environment,ETT,central arterial and venous catheter,infusion Genetic factors :ability of bacteria to cross BBB (Ecoli, GBS,LMC,Citrobacter, pneumococ) Sepsis present: -early onset sepsis -late onset sepsis -nosocomially acquired sepsis

Local infections Meningitis Meningoencephalitis Pneumonia Otitis Media Conjunctivitis Gastroenteritis Osteomyelitis and Septic Arthritis Urinary tract infection Infections of the Skin Omphalitis 9

Otitis Media INCIDENCE - otitis media develops in a minimum of 0.6% of all live births during the first month of life(2% to 3% in premature infants) -more often in male,cleft palate, and in infants requiring prolonged intubation. 10

ETIOLOGY - in the first 2 to 6 weeks of life: GBS,E. coli, and other gram-negative bacteria - younger than 6 to 8 weeks: S. pneumoniae (19% to 30% ), H. influenzae (14% to 25%), B-hemolytic streptococci(groups A and B) (5%),Gram-negative bacilli (E. coli and Enterobacter, Klebsiella, and Pseudomonas species) (7% to 18% ) -tympanocentesis in this age group, 40% to 50% have been sterile or judged nonpathogenic, anaerobic, Viral infection 11

PATHOGENESIS AND PATHOLOGY more common in premature than in term(related to the small size of the eustachian tube, with resultant obstruction)and secondary infection. Aspiration of infected amniotic fluid (leading cause) bottle-fed infants (the supine position during feeding lack of local immunity ) 12

CLINICAL MANIFESTATIONS The most common presenting symptoms are respiratory complaints such as cough or rhinorrhea and fever. Irritability,lethargy, vomiting, poor feeding, or diarrhea Young infants with otitis media often are asymptomatic. Erythema, dullness, and bulging of the pars flaccida of the tympanic membranes and decreased mobility of the tympanic membrane. Infants with typical facial or submandibular GBS cellulitis often have ipsilateral otitis 13

DIAGNOSIS In infants who appear ill or fail to respond to initial therapy : - culture and Gram-stained smears of purulent middle ear fluid obtained by myringotomy or tympanocentesis - Cultures of the nasopharynx(cannot be routinely relied on to guide selection of antibiotic - Blood cultures - Lumbar puncture 14

TREATMENT first 2 weeks of life: ampicillin +aminoglycoside or cefotaxime. Hospitalized premature infants :vancomycin + gentamicin Oral therapy with amoxicillin can be considered for well- appearing term infants older than 3 weeks who have had an uncomplicated intrapartum and neonatal course for broad- spectrum parenteral antimicrobial therapy. Treatment should be continued for 10 days longer, depending on the etiologic agent, the associated condition (e.g., sepsis or meningitis), and the clinical response to therapy. 15

Thank you 16