《新生儿脓毒症 ppt课件》由会员分享，可在线阅读，更多相关《新生儿脓毒症 ppt课件（45页珍藏版）》请在金锄头文库上搜索。
1、新生儿脓毒症,Neonatal Sepsis,Most common cause of neonatal mortality in developing countries. Up to 20% of neonates develop sepsis and 1% die of sepsis related causes. Incidence of systemic infection is 3% (India) with septicemia (75%) and pneumonia (25%)NNP Network, 2005,Early and Late-onset Sepsis,NeoRe
2、views, Vol.11, No.8, August 2010,Neonatal Sepsis,Septicemia Pneumonia Meningitis Arthritis Osteomyelitis Urinary tract infectionNNP Network, 2005,Neonatal Sepsis,Intramural admissions-Klebsiella pneumoniae (32.5%)-Staphylococcus aureus (13.6%) Extramural admissions-Klebsiella (27.5%)-S aureus (38%)S
3、ankar et al. Indian j Pediatr.2008;75:261-6,Neonatal Sepsis- Definitions,Probable sepsis (any one criteria):-Maternal fever or foul smelling amniotic fluid-PROM ( 24 hrs) or gastric polymorphs (5 hpf)-Positive sepsis screen (any two criteria)-Total WBC count (0.2)-Total WBC count 1mg/dl, micro ESR10
4、 mm-first hour-Radiological evidence of pneumoniaNNF, India,Neonatal Sepsis- Definitions,Culture positive sepsis-Isolation of the pathogen from blood,CSF, urine or abscess 72 hours of age Pathological evidence of sepsis on autopsy,NNF, India,Neonatal Sepsis- Incidence,Incidence of EOS is 1-2 cases/1
5、000 live births. This incidence is 10 fold higher in the VLBW infants. Incidence of early onset GBS has declined 80% from 1.7 cases /1000 live births (1993) to 0.34/1000 live births (2005) due to intrapartum antibiotic prophylaxis. Mortality 2.6% in term and 35% in VLBW infants. Survivors of EOS may
6、 have severe neurologic sequelae attributable to meningitis, hypoxemia, septic shock, PPHN etc.,Puopolo KM. NeoReviews 2008;9:e571-579,Neonatal Sepsis- Classification,Early onset sepsis (24 hours) More than three vaginal exam during labor Prolonged and difficult delivery with instrumentation Perinat
7、al asphyxia (apgar 72 hours) usually nosocomial or community acquired) Risk factors: NICU admission Poor hygiene Low birth weight Poor cord care Prematurity Bottle feeding Invasive procedure Superficial infection (pyoderma, umbilical sepsis) Ventilation Aspiration of feeds,Puopolo, K., NeoReviews 20
8、08, 9;571-e579,Organisms Causing Neonatal Early-onset Sepsis,Organisms Causing Early-onset Sepsis in Very Low-birthweight Infants,Puopolo, K., NeoReviews 2008, 9;571-e579,Risk Factors for All Causes of Early-onset Sepsis in Infants Weighing Less than 2000 g at Birth in the Era of Intrapartum Antibio
9、tic Prophylaxis,Puopolo, K., NeoReviews 2008, 9;571-e579,Risk Factors for Early-onset GBS Sepsis in the Absence of IAP,Puopolo, K., NeoReviews 2008, 9;571-e579,“Early” Pathogens (first week),Group B Strep (GBS) Incidence used to be 4-6/1000 live births (0.4%) Now 1mg/dl or Micro- ESR 15mm/hr LP (inc
10、idence of meningitis 0.3-3%) In EOS LP is indicated in the presence of + blood culture or symptoms of septicemia In LOS, LP should be done in all infants prior to starting antibiotics,Neonatal Sepsis-Investigations,LP should not be done in the following cases:-Asymptomatic babies investigated for ma
11、ternal risk factors-Premature babies with RDS-Critically ill and hemodynamically unstable babies,Normal CSF Values in the Newborn,Neonatal Sepsis-Investigations,Urine culture should not be part of sepsis evaluation in the first 72 hours of life. In LOS urine culture should be obtained by suprapubic puncture or catheterization. UTI diagnosis:10WBC/mm in a 10 ml centrifuged sample10 organisms/mL in catheterized specimenAny organism in a suprapubic specimen,
