1 Neonatal Sepsis By Dr. Nahed Said Al- Nagger

2 Objectives: Define neonatal sepsis. 1. List the causes make neonates susceptible to infection. 2. State the modes of transmission. 3. Write common predisposing factors to neonatal sepsis. 4. Discuss the assessment criteria for each body systems. 5. Describe the management of neonatal sepsis. 6. Design plan of nursing care for baby has neonatal sepsis.

3 Definition Sepsis or "septicemia" refers to a generalized bacterial infection in the blood–stream. Neonatal sepsis occurs when bacteria or their poisonous products, known as endotoxins, gain access to the blood–stream, causing systemic signs and symptoms.

4 Why neonates are susceptible to infection? They have immature immune system. Poor response to infectious agents. There is usually no local inflammatory reaction at the portal of entry to signal an infection and the resulting symptoms tend to be vague and nonspecific

5 Modes of Transmission during: - The prenatal period from maternal blood stream through the placenta. The natal period from infected amniotic fluid, or infection from birth canal (vagina or cervix).

The postnatal period through  contamination from: - other infants, personnel, - or subjects in the environment, such as, mechanical ventilators and venous and arterial catheters used for infusions, blood sampling.

Common Predisposing Factors to Neonatal Sepsis: Maternal Factors: early sepsis less than 3 days after birth: Premature rupture of membranes. Intrapartum fever more than 38 o C. Premature labor. Antenatal or antepartum asphyxia. Maternal urinary tract infection. Prolonged rupture of membrane more than 18 hours.

Neonatal Factors causing late sepsis 1-3 weeks after birth:  Prematurity.  Neonates with Endotracheal tubes, central lines, I.V. catheters,… etc.  Neonates who are formula fed.  Prolonged hyper alimentation.  Current neonatal diseases.

9 Neonatal Sepsis Perinatal asphyxia. Congenital defect.

10 Assessment Criteria (Clinical Manifestations) General signs:  "Failure to do well", "does not look right".  Unexplained respiratory distress.  Refuse to suckle.

11 Respiratory distress:  Tachypnea or apnea.  Irregular grunting respiration  Flaring nostrils.  Chest retractions.

12 Gastric distress:  Vomiting (vomitus may be bile stained).  Diarrhea.  Abdominal distention.  Absent stool as a result of paralytic ileus.  Poor sucking and feeding.

13 Skin manifestations may include:  Cyanosis or pallor.  Mottling.  Purpura.  Jaundice.  Lesions associated with specific organisms.

14 Central nervous system involvement:  Irritability.  Apathy.  Tremors.  Convulsions.  Coma.  Meningitis.

15 N.B. Fever frequently absent, body temperature commonly normal or subnormal. Indication of local inflammatory response is rare.

16 Diagnostic Tests: Diagnostic tests should be obtained before initiating the antibiotic therapy, such as, Blood. Urine. Tracheal. Cerebrospinal fluid culture.

17 Therapeutic Management: Initiating therapy even before reassuring the results: A. Aggressive Administration of Antibiotics: Before antibiotic administration, culture should be carefully obtained. The recommended antibiotics are ampicillin, gentamycin and penicillin.

18 B. Supportive Therapy  If respiratory distress or cyanosis is evident, oxygen administration or intubation and mechanical ventilator will be required.  Adequate hydration with intravenous fluid and electrolytes.  Blood transfusion may be needed to correct anemia or shock.

19 Nursing Management Nursing Diagnoses: Risk for injury related to effect of sepsis on all body systems Risk for fluid volume deficit related to increased metabolic rate, and insensible fluid loss. Risk for thermoregulation alteration related to stress of infection, unstable central temperature control.

20 Ineffective breathing pattern related to pulmonary and neuromuscular immaturity and decreased energy and fatigue. Risk for altered nutrition less than body requirement related to feeding intolerance (poor sucking and feeding, vomiting and diarrhea).

back Cord care The umbilical stump needs particular attention as there are risks of bleeding and infection. Keeping cord stump exposed, clean (with 70% alcohol, 4% chlorhexidine or simple soap and water) and dry A sterile clamp applied to the umbilical cord Binding, use of powders and traditional practices like application of cow dung, broken glass or herbs are harmful and should be discouraged!

22 Planning The goals of nursing management are the same as for any high- risk neonate with special emphasis on respiratory needs to: Minimize the harmful effect of sepsis on neonate and prevent complications.

23 Implementation Nursing care of the infant with sepsis is similar to the care of any high risk infant. The nurse's awareness of the potential modes of transmission allows her to identify those infants more at risk for developing sepsis.

24 The nurse should: – Observe closely the neonates who are at risk for developing sepsis to ensure early detection as early diagnosis and treatment can prevent complications. – Decrease muscle tone, activity, lack of interest intolerance of feeding and unstable body temperature.

25 1. Follow isolation technique. 2. Monitor vital signs. 3. Maintain a neutral thermal environment. Evaluation The effectiveness of nursing intervention is determined by continual reassessment and evaluation of care based on observation of signs and symptoms of sepsis.