1. By Dr. Gacheri Mutua

2.  Is a blood infection that occurs in an infant younger than 90 days old.  Occurs in 1 to 8 per 1000 live births highest incidence in low birth weight and gestation  NB: local figures not compiled. Observable higher incidence  Early onset vs. Late onset

3. EARLY ONSETLATE ONSET  Within 48hrs of life  Equal male and female incidence  Due to organisms acquired from birth canal  >80% of cases due to Group B Streptococcus and gram –ve bacteria  Risk factors : PROM >18hrs, fetal distress, maternal UTI, chorioamnionitis, multiple obstetric procedures, preterm birth  After 48hrs of life  Male predominance  Due to organisms acquired around the time of birth or in hospital  >70% due coagulase -ve Staphylococcus and Staph aureus  Risk: prolonged hospitalisation, IV catheters, endotracheal tubes, cross infection by staff/parents, urinary tract malformations

4.  General: pallor, lethargy, jaundice, fever, hypothermia  Respiratory: tachypnoea, apnoea, grunting, cyanosis  Cardiovascular: tachycardia/bradycardia, poor perfusion, hypotension  Cutaneous: petechiae, bruising, bleeding from puncture sites  GIT: poor feeding, vomiting, abdominal distension, feed intolerance, loose stools  CNS: lethargy, irritability, seizures

5.  Blood gas derangements- acidosis and lactate accumulation  Elevated C- reactive protein approximately 12hrs after onset of sepsis and returns to normal within 2 to 7 days of successful treatment  Deranged white blood cell count (esp. neutrophils)  Full blood count: platelets  Blood culture, Lumbar puncture, Urine culture  Hypoglycaemia, elevated bilirubin levels  Chest X-ray

6.  Septic baby should be managed in the Special Care Nursery where they can be observed closely  General measures:  Thermal care  Incubator nursing  Phototherapy if warranted  Monitoring of oxygen saturation, heart rate and BP  Respiratory:  Support for apnoea, hypoxia, hypercapnoea and respiratory distress

7.  Cardiovascular:  Plasma volume expanders like Normal Saline 10- 20mls/kg initially  Ionotropic support if in shock  Correct electrolytes, glucose levels  Correct haematological derangements- blood, platelets, clotting factors- fresh frozen plasma, exchange transfusion  Enteral feeds are withheld in an unstable infant  Hygiene:  Hand washing by staff and parents  Use of sterile equipment and protective equipment  Frequent changing of catheters, IV lines, urine bags  Sterilizing stethoscope between patients

8.  Early onset:  Benzylpenicillin 60mls/kg 12hrly, if meningitis suspected 120mg/kg/dose 12hrly  Gentamicin 5mg/kg IV 36hrly if >1200g, 48hrly if <1200g  Late onset:  Vancomycin 15mg/kg 18hrly for term babies  Gentamicin 5mg/kg36hrly for term babies 7days  Flucloxacillin 25mg/kg/dose 12hrly for preterm babies  Definite treatment dictated by organisms grown at blood culture where present or to be guided by bacterial pattern in the unit

9.  Hand washing by staff and parents  Use of sterile equipment and protective equipment  Frequent changing of catheters, IV lines, urine bags  Sterilizing stethoscope between patients  Minimize contact with the baby