NEONATAL SEPSIS

Neonatal Sepsis
 Neonatal Sepsis is an infection in the blood that spreads
throughout the body and occurs in a neonate. Neonatal Sepsis
is also termed as Neonatal Septicemia and Sepsis Neonatorum.


 Neonatal Sepsis has 2 types: The one that is seen in the first week
of life is termed as Early- onset sepsis and most often appears
in the first 24 hours of life. The infection is often acquired from
the mother. This can be cause by a bacteria or infection
acquired by the mother during her pregnancy, a Preterm
delivery, Rupture of membranes (placenta tissue) that lasts
longer than 24 hours, Infection of the placenta tissues and
amniotic fluid (chorioamnionitis) and frequent vaginal
examinations during labor. The second type or the Late-onset
Sepsis is acquired after delivery. This can be cause by
contaminated hospital equipment, exposure to medicines that
lead to antibiotic resistance, having a catheter in a blood vessel
for a long time, staying in the hospital for an extended period
of time.
Signs and symptoms of Neonatal
Sepsis includes:
 breathing problems (Hyperventilation) –earliest sign
 body temperature changes (Chills, Fever or low body
temperature )
 low blood sugar
 reduced movements
 reduced sucking
 Seizures
 slow heart rate/ Rapid heart beat
 swollen belly area
 vomiting
 yellow skin and whites of the eyes (jaundice)
 decreased urine output
IMMUNITY
 Immune System Development The immune system
begins very early in fetal development with the origin
of blood formation in the third week of gestation. In
the fourth week of gestation the thymus forms. The
thymus helps to mature and develop white blood cells
so that they can play a key role in fighting infections.
By the eighth week of gestation, T cells, B cells, and
natural killer cells can all be found in the thymus. T
cells, which make an important component in cell-
mediated immunity, are formed solely in the thymus.
B cells, which are the precursors of antibody producing
cells, are first produced in the liver but by 12 weeks
gestation move into the bone marrow where it
remains. Natural killer cells, which are cytotoxic cells
that have the ability to attack viruses, mature in the
thymus. Interestingly, greater concentrations of
natural killer cells are found in the peripheral blood of
newborns and the newborn usually has adult levels of
these cells at birth, but they diminish rapidly.
•Neutrophils are relatively numerous in both the term and pre-term infant. A
neutrophil is a type of white blood cell that defends the body from organisms
that cause infection. The stages of neutrophil development, from immature
to mature, are myeloblast, promyelocyte, myelocyte, metamyelocte, band,
and segmented neutrophil. When an infection is present, the neutrophils
migrate out of the capillaries and into the infected site, where they ingest
and destroy the pathogens causing the infection. The amount of circulating
neutrophils in the newborn peaks around 12 hours after birth and then starts
to decline to normal levels. Even though a large number of circulating
neutrophils can be found in the newborn, the bone marrow storage pool of
neutrophils at birth is only 20% to 30% of the circulating pool in adults.
Differences in Immune Responses in Full and Preterm Infants
Immune System Component Full Term Infant Preterm Infant

Immunoglobulin G Complete placental transfer, Incomplete placental transfer,

concentrations comparable to mother concentrations decreased

Lymphocytes Concentrations of T and B cells Concentrations of T and B cells

comparable to those in adults with comparable to those in adults with
normal response to antigens normal response to antigens

Complement 50%-75% of concentration in adult Decreased concentration

Neutrophils Elevated numbers at birth, with Elevated numbers at birth, with

impaired functional ability impaired functional ability

Monocytes Normal number at birth but have Normal number at birth but have
impaired chemotaxis impaired chemotaxis

Macrophages Normal number at birth but decreased Normal number at birth but decreased
function function

Natural Killer Cells Concentration similar to adult level, Concentration similar to adult level,
but have diminished cytotoxic effects but have diminished cytotoxic effects
Immune System Physiology
 Despite the immune system and immune system components, early
development during gestation the newborn still remains vulnerable
to infections after they are born because of the immaturity of their
immune system. A newborn has a poor response to invading
pathogens. This immune response will gradually improve with age.
During the initial postpartum phase, the infant relies on maternal
antibodies and the mother’s breast milk, which is rich with
immunoglobulins. When a pathogenic organism overcomes the
infant’s defenses, infection and sepsis result. Sepsis is defined as
the presence of microorganisms or their toxins in blood or other
tissues. Newborn sepsis is still one of the most significant causes of
neonatal disability and death today. Reviewing the functions of the
infant’s immune system will help provide a better understanding of
the interaction between the pathogenic organisms and the
newborn’s susceptibility to infection. Infections occur when the
infant comes in contact with a pathogenic organism. The organism,
whether it is a virus, fungus, or bacteria, enters into the infant’s
body system and begins to multiply. The infant’s immune system
response to an organism is divided into three phases. The first
phase is the primary or nonspecific phase, which occurs
immediately following the infant’s inoculation with a pathogenic
organism. During this phase, there is a migration of the neutrophils
to the primary site of the infection. The neutrophils enter into the
cells through membrane filters and adhere to the pathogen.
Ingestion and destruction of the invading organism then takes
place.
 Risk Factors
Intrauterine:
•

Intrauterine or factors that increase the risk before birth include the following: poor
•

prenatal care, poor nutrition, recurrent abortions, and substance abuse. Intrauterine
infections occur when pathogenic organisms cross the placenta into the fetal
circulatory system. The organisms, such as cytomegalovirus (CMV), can reside in the
amniotic fluid,. Other organisms ascend from the vaginal track, infecting the
membranes and causing them to rupture. This rupture of membranes can lead to
infections of the respiratory and gastrointestinal tract of a newborn.
Intrapartum:
•

Intrapartum or factors that increase the infants chance of becoming infected during the
•

birthing process include: prolonged rupture of membranes (>12 to 18 hours), urinary

tract infections, preterm labor, prolonged or difficult labor, maternal fever, colonization
with Group B Streptococcus (GBS), and maternal infections. Most infections during the
birthing process are related to the infant coming into unavoidable contact with an
infected birth canal. The birth canal can host bacteria that an infant’s immune system
cannot defend against.
Postpartum:
•

Postnatal infections may be contracted after delivery, as in the case with infections
•

contracted during resuscitation, or as a result of a nosocomial infection due to

improper hand washing. Infections in the postnatal period are more common in those
infants who require foreign objects be introduced into their systems. Items like
endotracheal tubes or indwelling catheters increase the risk of an infant becoming
septic.
Source: Risk Factors:
 Maternal  Poor prenatal care
  Poor nutrition
•
 Substance abuse

 Intrapartum  Premature rupture of
 membranes
  Maternal fever
 Prolonged labor

 Maternal UTI
•

 Neonatal  Male Birth
 asphyxia
 Low birth weight

Trends in Neonatal Sepsis
 Mortality/Morbidity
•

Sepsis is a major cause of
death during the first few
months of life causing 13-
15% of all neonatal deaths.
The mortality rate of neonatal
sepsis can be as high as 50%
for infants who are not
treated or when treatment is
not begun quickly. A serious
morbidity of neonatal sepsis
is neonatal meningitis.
Research has shown that
neonatal meningitis occurs in
2-4 per 10,000 infants and of
those infants diagnosed with
neonatal meningitis their
chance of survival
significantly decreases. It is
responsible for 4% of all
 Race, Sex, & Age
 Current research has
•
shown that African-American
infants have an increased
incidence of Group B Strep
(GBS) disease as well as
acquired or late sepsis. To help
counter this many professional
healthcare groups have
recommend guidelines for
controlling risk factors in this
race. Despite these changes in
screening and treatments,
African-American infants still
remain at the highest risk for
sepsis. Orlando Regional
Healthcare, Education &
Development © Copyright
2004 Page 8 Male infants have
a higher incidence of sepsis
Treatment & DX exams
 Blood culture
 Babies in the hospital and
is a laboratory test to check for
those younger than 4
•

bacteria or other microorganisms in a

weeks old are started on blood sample
antibiotics before lab •

results are back. (Lab  C-reactive protein

results may take 24-72 is a test that measures the
hours.) This practice has amount of a protein in the
saved many lives. blood that signals acute
inflammation.
 
 Older babies may not be  CBC (complete blood count)
given antibiotics if all lab the number of red blood cells
results are within normal
•

(RBCs) white blood cells (WBCs)The

limits. Instead, the child total amount of hemoglobin in the
may be followed closely blood The fraction of the blood
on an outpatient basis. composed of red blood cells (
hematocrit)The size of the red
blood cells (mean corpuscular
 volume, or MCV)
•
 Generic Name Date Route of General Action Client’s response
Brand Name Ordered/ administration
Date Taken Dosage and
frequency and
Administration

Generic Name: Jan. 23- 150mg Inhibits cell wall Client responded well and had no
Ampicillin 25,2010 synthesis during adverse reaction to drug.
Brand Name: bacterial
Ampicin multiplication.
Classification:
Anti infectives

Generic Name Date Ordered/ Route of General Client’s response

Brand Name Date Taken administration Action
Dosage and
frequency and
Administration

Generic Name: Jan.23-25,2010 2 x a day for 2 days Inhibits cell wall A reduction in
cefixime synthesis during neutrophils has been
Brand Name: bacterial noted.
Suprax multiplication
MANAGEMENT:
 Treatment begins with careful monitoring of the
infant’s vital signs and regulation of the thermal
environment.
 Supportive therapy for a septic infant starts with
the administration of oxygen when respiratory
distress or hypoxia becomes present.
 Invasive respiratory support such as continuous
positive airway pressure (CPAP) or to be placed
on a ventilator if they are suffering from apneic
episodes.
 Antibiotic therapy is continued for 7 to 21 days if
the cultures are positive, or it is discontinued in
3 days if cultures are negative.
 NURSING CONSIDERATIONS:

Skilled observation and ongoing

•

assessments. Recognition of a problem is

paramount in importance. It is most often
the nurse who observes and identifies that
something “just isn’t right” with the infant.
This is due to the fact that the nurse
maintains constant assessment and
documentation of subtle changes in the
infant’s vital signs, physical assessments,
feeding tolerance, responsiveness, and/or
general behavior.
•St art ing and m aint aining IV access for drug t herapy. Com m on
sit es in t he infant include t he hand and arm , as w ell as t he
veins found in t he scalp and foot . If t he infant is going t o
require ext ensive ant ibiot ic t herapy, a peripherally insert ed
cent ral cat het er (PICC) m ay be considered.
•
•Total care of infants with sepsis involves decreasing any additional
physiologic and/or environmental stress. This includes providing an
optimum thermoregulated environment and anticipating potential
problems, such as dehydration or hypoxia.
•
•Precautions need to be implemented to prevent the spread of infections
to other newborns. To be effective, precautions must be carried out by all
caregivers that come in contact with the sick infant. aProper
handwashing, use of disposable equipment, disposing of excretions, and
adequate housekeeping of the environment and equipment are
essential.
•
•Since nurses are the most constant caregivers involved with sick
infants, it is usually their responsibility to oversee that everyone
maintains all phases of isolation.
 DISCHARGE PLAN

M - Medication
- ampicillin 150mg
-
E - Exercise
- Stressed that the baby sleeps most often times
T - Treatment
- Stressed importance of complying with the medications
H - Health Teachings
- Instructed to bring back the baby in the hospital for his medication
- Instructed on the time the medication will be given
the injection site; sleeplessness; vomiting.
- Instructed to expose the baby to sunlight
- Instructed that formula milk is only good for 4 hours
-- Instructed to burped the baby after each feedings
- Instructed to bathe daily their Baby
D - Diet
-Instructed to feed the baby as tolerated with strict aspiration
precaution
By: Group 1
Ayna Chiqui Ismael
Richmond Rombo
Riza Diki
Emie Joy Espańola
Jesselie Lapinig