1. High-Risk related to Infectious Processes
Sepsis

2. Sepsis
Sepsis or septicemia: refers to a generalized bacterial infection in the bloodstream.
Neonates are highly susceptible to infection as a result of:
Diminished nonspecific (inflammatory).
There is usually no local inflammatory reaction at the portal of entry to signal an infection so diagnosis may be delayed.
Specific (humoral) immunity such as:
Impaired phagocytosis.
Delayed chemotactic response.
Minimal or absent immunoglobulin-A IgA, and IgM.
Decrease complement levels.

3. Sepsis Neonatal sepsis is common in infant at risk: Preterm infant.
Infant born after a difficult or traumatic labor and delivery
Sepsis can be acquired from:
Prenatally across the placenta from the maternal bloodstream e.g. viruses as cytomegalovirus (CMV) , toxoplasmosis, treponema pallidum (syphilis)
During labor from ingestion or aspiration of infected amniotic fluid

4. Sepsis Types of sepsis : Early sepsis: less than 3 days .
Acquired in the perinatal period.
Infection can occur from direct contact with organisms from the maternal GI and genitourinary tracts.
The most common organisms are group B streptococcus (GBS) and E-coli.
(GBS) cause of death to (50%) infants.
Haemophilus influenzae and Candida albicans are common seen in early onset sepsis in VLBW infants .

5. Sepsis 2. late sepsis: 1-3 weeks after birth . Primarily nosocomial.
The common organisms are staphylococci, klebsiella, enterococci, pseudomonas
Bacterial invasion can occur through sits as umbilical stump, skin, mucous membranes of the eye, nose, pharynx and ear.

6. Sepsis 3. Postnatal infection:
Acquired by cross-contamination from other infants, personal. Or objects in the environment
Bacterial that are commonly called “water bugs” are found in water supplies, humidifying apparatus, suction machines
Coagulase - negative staphylococcus usually colonize the skin may infect indwelling venous and arterial catheters used for infusion, blood sampling.

7. Diagnostic Evaluation
1. Diagnostic Evaluation is based on clinical S&S: box 9 -11, p:283
General signs: infant not doing well, poor temperature control (hypothermia, hyperthermia)
Circulatory system: pallor, cyanosis, mottling. Cold, clammy skin. Hypotension, edema, irregular heart beat_ bradycardia, tachycardia.
Respiratory system: irregular respirations, apnea, or tachypnea, grunting ,dyspnea, retractions.

8. Diagnostic Evaluation
Central nervous system: diminished activity_ lethargy, hyporeflexia, coma. Increase activity_ irritability, tremors, seizures.
Full fontanel.
Increased or decreased tone. Abnormal eye movements.
Gastrointestinal system: poor feeding, vomiting, diarrhea or decreased stooling, abdominal distention. hepatomegaly. Hemoccult-positive stools
Hematopoietic system: jaundice, pallor, petechiae, ecchymosis, splenomegaly

9. Diagnostic Evaluation
2. Isolation of the specific organism is always attempted through cultures of blood, urine, CSF.
Blood studies: anemia, leucopenia, leukocytosis,
Elevated of immature Neutophils, increase or decrease of total Neutophils and change morphology also suggest an infectious process in the neonate.
C-reactive protein serial measurements may have a significant role in establishing or excluding the diagnosis of sepsis
Prevention:
programs to screen pregnant women for GBS colonization and treatments of those women in labor.
Screening programs for other maternal infections including hepatitis B and HIV

10. Prevention:
Nursery procedures aimed at minimizing the risk of nosocomial infections include:
good hand washing techniques.
Appropriate isolation precautions where indicated.
The adoption of recommendation standards for spacing of infant beds.

11. Therapeutic management
Antibiotic therapy is initiated before laboratory result are available, it is continued for 7-10 days if cultures are positive ,discontinued in 3 days if cultures are negative and the infant is asymptomatic IV infusion,
Antifungal and/or antiviral therapies are implemented as appropriate, depending on causative agents
Supportive therapy usually involves
administration of oxygen if need for it.
Regulation of fluid.
Correction of electrolyte or acid-base balance.
Temporary discontinuation of oral feedings.
Blood transfusions may be needed to correct anemia .

12. Prognosis
Sever neurologic and resiratory sequelae may occur in ELBW and VLBW infants as a result of early-onset sepsis.
Late-onset sepsis and meningitis may also result in poor outcomes for immunocompromised neonates .

13. Nursing consideration
Nursing care of the infant with sepsis involves observation and assessment as outlined for as any high-risk infants.
Awareness of the potential modes of infection transmission.
Knowledge of the side effects of the specific antibiotic and proper regulation and administration of the drug are vital.
Nurses must be alert for evidence of such complications.
Precaution are important to prevent the spread of infection to other newborn:
Proper hand washing. And short fingernails
Using of disposable equipments
Proper disposing of excretions e.g. vomitus, stool.