2. Neonatal Sepsis

3. Sepsis neonatorum is the term used to describe any systemic bacterial infection any systemic bacterial infection documented by a Positive blood culture Positive blood culture in the first month of life. in the first month of life.

4. SYMPTOMS AND SIGNS The signs and symptoms of neonatal sepsis often are nonspecific The signs and symptoms of neonatal sepsis often are nonspecific

5. CLINICAL MANIFESTATIONS level of A ctivity level of A ctivity

6. CLINICAL MANIFESTATIONS Pattern of F eeding Pattern of F eeding Abdominal distention / lavage / …

7. muscle T one muscle T one CLINICAL MANIFESTATIONS

8. level of A lertness level of A lertness

9. respiratory status or effort ( B reathing) CLINICAL MANIFESTATIONS

11. Peripheral P erfusion Peripheral P erfusion

12. CLINICAL MANIFESTATIONS level of A ctivity level of A ctivity Pattern of F eeding Pattern of F eeding muscle T one muscle T one level of A lertness level of A lertness respiratory status or effort ( B reathing) respiratory status or effort ( B reathing) Peripheral P erfusion Peripheral P erfusion The negative predictive value (NPV) of this scoring system was 96% The negative predictive value (NPV) of this scoring system was 96%

13. observational findings, they are an important aspect of the evaluation Thus, although observational findings alone cannot replace the physical examination and laboratory studies, they are an important aspect of the evaluation.

14. Temperature elevation Temperature elevation in full-term infants is uncommon uncommon. in Temperature elevation is infrequently only associated with systemic infection when only a single elevated temperature a single elevated temperature occurs. sustained Temperature elevation that is sustained longer than an hourfrequently longer than an hour is frequently associatd infection with infection. without other signs Temperature elevation without other signs of in infection is infrequent

16. Early-onset disease Early-onset disease GBS, E. coli and other gram-negative enteric bacilli, and L. monocytogenes: ampicillin + an aminoglycoside (gentamicin) Multidrug-resistant bacteria: Multidrug-resistant bacteria: tobramycin and amikacin. (Ampi + Amika ) tobramycin and amikacin. (Ampi + Amika ) If meningitis is suspected: If meningitis is suspected: cefotaxime, for better CNS penetration cefotaxime, for better CNS penetration. (Ampi + Amika + Cefo ) (Ampi + Amika + Cefo ) ampicillin - gentamicin )

17. late-onset disease ( community acquired) neonatal pathogens of early onset potential community acquired pathogens S. pneumoniae,N.meningitidis & H.influenza. Empirical therapy for late-onset disease acquired in the community should provide coverage for the same neonatal pathogens of early onset and for potential community acquired pathogens, such as S. pneumoniae,N.meningitidis & H.influenza. meningitis frequently late-onset sepsis good CNS penetration Because meningitis frequently is a component of late-onset sepsis, antibiotics with good CNS penetration should be selected. Ampicillin., cefotaxime Ampicillin and a third-generation cephalosporin (e.g., cefotaxime) are commonl recommended. (Ampi + cefo ) (Ampi + cefo ) Ampicillin - Cefotaxime

18. late-onset disease (nosocomial acquired) CONS, enterococci, gram-negative enteric bacilli (including drug-resistant strains), and fungi: all most Vancomycin generally is active against all staphylococcal species, streptococci, and most enterococci. for initial therapy: (Vanco + genta or Amika ) Vancomycin and gentamicin are commonly used for initial therapy: (Vanco + genta or Amika ) meningitis when gram-negative meningitis is a concern: (Vanco + Cefo ) Cefotaxime PeL PEL Cefotaxime does not have activity against P seudomonas, e nterococci, L. monocytogenes. : PEL Ceftazidime (Vanco + Cefta ) Vancomycin-Cefotaxime