I Injury * Accidental Infection *Sudden infant death Syndrome *Sever pneumonia *Deliberate Congental Anomaly *Sepsis * Subendocardiac *Gasteroenteritis *Fibroelastosis *Long QT Syndrome *Cardiac Anomaly *Pulmonary Anomaly *Neurological Anomaly

FT baby 6days old, producte of home vaginal delivary with PROM>24hr,he had fever&vomting,poor sucking laste 3days.O/E ; Lethargic,febrile(38C) NN reflex weak

Pathways of ascending or intrapartum infection

Pathogenesis of hematogenous transplacental infections

It is the systemic inflammtory respones to an infection process. The most commen cause; GBS, E-Coli,L-monocytogenus Other causes are ;(non-bactrial) Viral, protozal, fungal

TRANSPLACEN TALPERINATALPOSTNATAL CMVAnerobic bacteriaAdenvirus HSVChlamydiaCandida spp. Mycobacterium Tunerculosis Enteric BacteriaCoagulase Neg. Staphyloccoci Rubella virusGBSCMV T. PallifdumH. influenzaeEchovirus VZVHSVEnteric bacteria L. monocytogenesInfluenza virus,A, B MycoplasmaParainfluenza Pseudomonas RSV,staphylococcus Aureus Mycobacterium Tuberculosis Etiologic Agents of Neonatal Pneumonia According to Timing of Acquisition

BACTERIA EARLY ONSET LATE ONSET, MATERNAL ORIGIN LATE ONSET, NOSOCOMIAL LATE ONSET, COMMUNITY GRAM POSITIVE Clostridia + + Enterococci + ++ Group B streptococcus Listeria monocytogenes ++ Other streptococci ++ + Staphylococcus aureus Staphylococcus, coagulase negative Streptococcus pneumoniae + ++ Viridans streptococcus + ++ GRAM NEGATIVE Bacteroides + + Campylobacter + Citrobacter + + Enterobacter + Escherichia coli Haemophilus influenzae + + Klebsiella + Neisseria gonorrhoeae + Neisseria meningitidis + + Proteus + Pseudomonas + Salmonella + + Serratia + OTHERS Treponema pallidum ++ Mycobacterium tuberculosis +

Maternal Intrapartum fever(>38) PRM(>18hr) Chorioaminionits PT labor(<37wk) Neonatal Male sex PT& LBW Cong—anomalies Immunity defect Galactosemia(E-Coli)

General ; Fever.temperature instability Poor feeding GIT; Diarreh,Vomiting Abd-distention Respiratory; Apnea,RDS Renal; oliguria CNS ; Irritability,lethargy,seizers High pitch cry,hypotonia, Full fontanel, CVS; Pallor,mottling,HR( ) hypotention, Hematology; Jaundies, pallor,petechia,purpura Bleeding

sepsis workup; *Culture; Blood—CSF—Urine *CBC; WBC( 0,2 *CRP *G.stain;CSF,Urine;Infected side *Chest Xry

Once the pathogen has been identified & antibiotic sensitivities determined, the most appropriate drug or drugs should be selected. For most gram-negative enteric bacteria, Ampicillin & an Aminoglycoside or a 3rd-generation cephalosporin (cefotaxime or ceftazidime) should be used. Enterococci should be treated with both a penicillin (Ampicillin or piperacillin) & an aminoglycoside because the synergy of both drugs is needed. Ampicillin alone is adequate for L. monocytogenes, and penicillin suffices for GBS. Clindamycin or metronidazole is appropriate for anaerobic infections

Is determined by pattern of disease and the organisms that are common for the age of infant& the flora of the nursery. Duration of Rx; meningits(14—21days) Pneumonia(7—10)

CVS; CHD.myocaditis,PPHN GIT; Necrotizing enterocolitis spontanousGITperfora- tion Hematology; Nnpurpuric fulminans Sever anemia Immune mediated neutropenia&thromboc- ytopenia Respiratory; RDS,lung hypoplasia TEOF,aspiratin pneumonia, Metabolic; Hypoglysemia Galactosemia CNS; HIE.Infant botulism ICH

The risk factors for death or for moderate or sever disability include; *Duration of seizeres >72hrs *Coma *Necessity for the use of inotropic agents *Lukopenia

MANIFESTATIONPATHOGEN Intrauterine Growth RestrictionCMV, Plasmodium, rubella, toxoplasmosis, Treponema pallidum, Trypanosoma cruzi, VZV Congenital Anatomic Defects CataractsRubella Heart defectsRubella HydrocephalusHSV, lymphocytic choriomeningitis virus, rubella, toxoplasmosis Intracranial calcificationCMV, HIV, toxoplasmosis, T. cruzi Limb hypoplasiaVZV MicrocephalyCMV, HSV, rubella, toxoplasmosis MicrophthalmosCMV, rubella, toxoplasmosis Neonatal Organ Involvement Anemia CMV, parvovirus, Plasmodium, rubella, toxoplasmosis, T. cruzi, T. pallidum CarditisCoxsackieviruses, rubella, T. cruzi EncephalitisCMV, enteroviruses, HSV, rubella, toxoplasmosis, T. cruzi, T. pallidum HepatitisCMV, enteroviruses, HSV HepatosplenomegalyCMV, enteroviruses, HIV, HSV, Plasmodium, rubella, T. cruzi, T. pallidum HydropsParvovirus, T. pallidum, toxoplasmosis LymphadenopathyCMV, HIV, rubella, toxoplasmosis, T. pallidum OsteitisRubella, T. pallidum Petechiae, purpuraCMV, enteroviruses, rubella, T. cruzi PneumonitisCMV, enteroviruses, HSV, measles, rubella, toxoplasmosis, T. pallidum, VZV RetinitisCMV, HSV, lymphocytic choriomeningitis virus, rubella, toxoplasmosis, T. pallidum, West Nile virus RhinitisEnteroviruses, T. pallidum Skin lesionsEntroviruses, HSV, measles, rubella, T. pallidum, VZV ThrombocytopeniaCMV, enteroviruses, HIV, HSV, rubella, toxoplasmosis, T. pallidum Clinical Manifestations of Transplacental Infections

Aggressive management of suspected maternal chorioamnionitis with antibiotic therapy during labor,along with rapid delivaryof the infant,reduces the risk of early Nnsepsis. Intrapartum chemoprophylaxsis reduced the vertical transmission of GBS.

That is unexpected by history and unexplained by a thorough postmortem examination,which includes a complete autopsy,investigation of the scene of death, and review of medical history.

Maternal ; Smoking,Drugs Nutritional deficiency Decreased age,education Single marital status IGR,increas parity Low socioeconomic status Infant; Age(2-4mo),PT,Male Pron sleep position Growth failure Recent(febrile) illness Soft bedding

Objectives; *Definition Factors ; Risk * Mternal &neonatal * Types & clinical manifestation l Diagnosis * Treatment * Prognosis * Prevention * *DD