Neonatology: Neonatal Septicemia

Lecture points Morbidity and mortality The compromised host of the neonates in immunology Pathogens for clinical consideration Clinical manifestation Clinical Management

Incidence 1% ～ 10%, in live birth 15-20%, in VLBW

Incidence ‰ ‰ Gross incidence Comparison: US and developing countries

Neonatal Septicemia Death rate: US

Neonatal Septicemia Death rate ： developing countries LONS 7.5% death rate: 9.8%~12%

Immature development in body defense Imperfect function Less experience of exposure to environment and pathogens Affected by maternal antibodies Immunological features in neonates

Non-specific Immune: Poor barriers function Undeveloped complement activation capacity Relative fewer neutrophil, Immature Function Lower ILs, lower level of cytokines Immunological features in Neonates

Specific Immune: Quantities and quality of Ig G, A, M T, B cell: quantities, quality and their function Immunological features in Neonates

Pathogens Domestic: –Staphylococcus: most commonly seen –Escherichia coli, etc. –G- bacillus US: –GBS: the leading pathogen during 1970’s –Escherichia coli: the leading pathogen during 1990’s

Pathogenic Changes ‰ EONS: Changes by G + vs. G - Early 1990’s Late 1990’s

Pathogenic Changes

Relevant factors of pathogenic changes Change of colonized pathogens in maternal birth canal GBS Screening Preventive antibiotic therapy used during pre partum Ampicilline for the mother with GBS positive : pre partum and Intro-partum GBS Septicemia  Efficacy ： around 70% （ vs. control P < ）

Pathogens based on the types in developed country EONS ： –E. coli –Listeria monocytogenes, Pseudomonas –Meningococcus –Enterococcus and GBS LONS ： –Coagulase-negative Staphylococcus –Haemophilus influenza bacillus –Other pathogens

Pathogens based on the types in developed country

LONS (48 hours after birth) Mainly: G + Coagulase-negative Staphylococcus Partly reported ： Staphylococcus epidermidis, GBS and E. coli EONS (within hours after birth) G + = G - G + ： mainly Klebsiella pneumoniae and E. coli G - ： Enterococcus commonly seen VEONS (within 24 hours after birth) Klebsiella 、 E. coli 、 Enterococcus Pathogens based on the types in developing country

Early onset dominant Related with the maternal and the intro-partum high risk factors Pathogens based on the types in developing country

Pathogens isolated in China main isolates from blood culture bsed on the ages: n=671/458/1849 临床儿科杂志： 浙江大学附属儿童医院资料

Pathogens isolated in China 中华儿科杂志 01-6 ；重庆儿科医院资料 Domestic data ： main isolates: n=815

main isolates account for during different periods: n=436 临床儿科杂志 02-5 ：深圳市人民医院儿科资料 Pathogens isolated in China

临床儿科杂志 02-5 ：深圳市人民医院儿科资料 main isolates account for during different periods: n=436

Pathogens isolated in China main isolates account for during different periods: n=606/475 临床儿科杂志： 哈尔滨儿童医院资料

The path of Infection Path: 1.Intrauterine infection 2.Intro-partum infection 3.Post delivering infection

Maternal intro-partum fever (OR=4.1 CI= ) Repeated Vaginal examinations (OR=2.9 CI= ) Among GBS Sepsis, Dystocia and maternal fever account for 49% Prolonged membrane rupture ≥18 hour （ 79% ） Prematures and LBW Later onset sepsis: PDA, Long time of Intravascular catheter, various of invasive procedure, BPD Risk factors of sepsis occurrence

Clinical manifestations General ： –Anorexia –Less Crying –Fewer physical activities –Lower temperature or fever –Poor weighting gain –Persistent Jaundice Focal: –Omphalitis –Skin infection –Blepharitis (eyes) –Otitis media –Paronychia (nails)

Clinical manifestations Toxic: –Shock –Hepatosplenomegaly –Skin deposition point –Distension –Anemia Complication: –Meningitis –Pneumonia –Peritonitis –Urinary Tract Infection –Scleredema –DIC –Toxic myocarditis

Laboratories and investigation aids Peripheral whole blood test Blood culture Others: –CRP/ PCT –Smear of WBC: check bacterial –CSF –Urine CXR

Clinical Management Antibiotic therapy Selection based on the pathogen isolated Early, Adequate dose, IV Duration: –2 weeks for G +, 3 weeks for G -. –Longer duration for meningitis and severe

Supportive therapy –Dehydration –Correct metabolic acidosis –Maintenance of electrolyte and Acid-base balance –Enough energy supply –Keep warm –Correct hypoxemia –Immunological therapy: IVIG Clinical Management

Complication treatment –Shock –DIC –Scleredema –Respiratory failure –Conversion –Jaundice –Focal lesion Clinical Management

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