Infant sepsis : symptoms, investigations & treatment

Infant sepsis

We have described in article :

Symptoms of infant sepsis

Investigations of infant sepsis

Treatment of infant sepsis

Risk factor of infant sepsis

prevention of infant sepsis

Infant sepsis

Symptoms of infant sepsis : 

Mostly non-specific :

  1. Unable to suck.
  2. Poor cry, lethargy or abnormally sleepy.
  3. Hypothermia or fever.
  4. Poor perfusion.
  5. Hypothermia
  6. Absent primitive reflex.

Specific Symptoms /clinical feature :

  • Central nervous system : Irritability, full frontanelle, seizure, vacant stare, high pitch cry, neck retraction. Presence of other feature suggestion meningitis.
  • Gastrointestinal system : Feed intolerance, vomiting, diarrhea, abdominal distention, paralytic ileus, necrotizing enterocolitis etc.
  • Respiratory system : Grunting, aponea, irregular breathing, fast breathing, severe chest indrawing or cyanosis.
  • Cardiovascular system : Bradycardia or tachycardia, hypotension, poor perfusion, shock.
  • Skin changes : Mooting, sclerema, multiple pustules, permbilical redness or foul smelling umbilical discharge.
  • Haematological : Bleeding, petechiae, purpura, jaundice.
  • Urinary : Oliguria e anuria.

Investigations of infant sepsis:

Sepsis screening :

  • Total leukocyte count (<5000/mm3).
  • Differential count (e.g. absolute neutrophil county low.
  • Immature to total neutrophil (I/T) ratio 0.2
  • Micro ESR 15 mm in 1 hour. Elevated haptoglobin (> 1mg/dl).

Other investigations :

  • Blood culture.
  • Urine culture
  • CSF study to assess evidence of meningitis.
  • X ray chest and abdomen.
  • USG of brain or other as individualized.

Treatment of infant sepsis : 

1) Supportive care : 

  • Maintenance of temperature maintaining optimum room temperature (>25°C wrapping warming in radiant water or incubator).
  • Hypoglycaemia : by 10% dextrose
  • Treatment of shock :  Dopamine or dobutamine along with volume expander (normal saline, albumin, blood).
  • In case of DIC : fresh frozen plasma (FFP), vitamin K. platelet infusion, exchange transfusion.
  • Assess hypoxia by pulse oximetry and initiate oxygen therapy or ventilator support.
  • Control of seizure by appropriate medication.
  • Monitor for SIADH urine output, hyponatremia, serum and urinary osmolarity.
  • Treat metabolic acidosis with bicarbonate and fluid replacement.
  • Care of umbilicus :
  • Feeding : 

.Breast feeding

.If not possible the nasogastric feeding of expressed breast milk.

.If the baby cannot tolerate oral of nasogastric feeding, then Iv fluid (27% less than normal daily allowance).

2) Antimicrobial therapy :

  • Empirical therapy : ampicillin plus gentamicin, or ampicillin plus cefotaxime.
  • Duration of antibiotic therapy : usually 7-10 days or at least 5-7 days after a clinical response has occurred.
  • For meningitis :

.Gram positive bacteria 14 days.

.Gram negative bacteria-21 days.

3) Best defense modulation:

  • Granulocyte transfusion.
  • Immunotherapy (IVIG).

4) Follow up :  Every 4-6 hourly to monitor-

  • Vital signs : heart rate, respiratory rate, temperature.
  • Primitive reflex : suckling, rooting, moro and others.
  • Skin condition : texture, colour condition, tissue perfusion and any mottling.
  • Anterior fontanelle : any bulging or fullness.
  • Abdomen : any distension, presence of bowel sound, passage of urine and stool.
  • Any untoward sign : convulsion, apnoea, cyanosis etc.

Risk factors of infant sepsis / infection :

  1. Rupture of membranes > 18 hours.
  2. Maternal intra-partum fever > 100.4 °F.
  3. Low birth weight infant (<2.5 kg).
  4. Prematurity (<37 weeks).
  5. Chorioamnionitis.
  6. Male infants.
  7. Mother with group B Beta haemolyticus streptococci (GBS) infection.
  8. Repeated per-vaginal examination (P/V/E) in labour.
  9. Invasive procedures of monitoring.

Prevention of infant sepsis / infection:

  1. Proper antenatal care of the mother.
  2. Treatment of premature rupture of membranes (PROM) with proper antibiotic.
  3. Maintenance of all aseptic precaution during delivery of the baby.
  4. Proper care of the umbilical cord.
  5. Proper care of the skin, eye and ear.
  6. Baby should be kept warm and clean.
  7. Less handling of the baby.
  8. Hand washing before handling of the baby.
  9. Early diagnosis and treatment of infections.

1 Response

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