By Dr. Gacheri Mutua Is a blood infection that occurs in an infant younger than 90 days old. Occurs in 1 to 8 per 1000 live births highest incidence in low birth weight and gestation NB: local figures not compiled. Observable higher incidence Early onset vs. Late onset EARLY ONSET Within 48hrs of life Equal male and female incidence Due to organisms acquired from birth canal >80% of cases due to Group B Streptococcus and gram –ve bacteria Risk factors : PROM >18hrs, fetal distress, maternal UTI, chorioamnionitis, multiple obstetric procedures, preterm birth LATE ONSET After 48hrs of life Male predominance Due to organisms acquired around the time of birth or in hospital >70% due coagulase -ve Staphylococcus and Staph aureus Risk: prolonged hospitalisation, IV catheters, endotracheal tubes, cross infection by staff/parents, urinary tract malformations General: pallor, lethargy, jaundice, fever, hypothermia Respiratory: tachypnoea, apnoea, grunting, cyanosis Cardiovascular: tachycardia/bradycardia, poor perfusion, hypotension Cutaneous: petechiae, bruising, bleeding from puncture sites GIT: poor feeding, vomiting, abdominal distension, feed intolerance, loose stools CNS: lethargy, irritability, seizures Blood gas derangements- acidosis and lactate accumulation Elevated C- reactive protein approximately 12hrs after onset of sepsis and returns to normal within 2 to 7 days of successful treatment Deranged white blood cell count (esp. neutrophils) Full blood count: platelets Blood culture, Lumbar puncture, Urine culture Hypoglycaemia, elevated bilirubin levels Chest X-ray Septic baby should be managed in the Special Care Nursery where they can be observed closely General measures: Thermal care Incubator nursing Phototherapy if warranted Monitoring of oxygen saturation, heart rate and BP Respiratory: Support for apnoea, hypoxia, hypercapnoea and respiratory distress Cardiovascular: Plasma volume expanders like Normal Saline 1020mls/kg initially Ionotropic support if in shock Correct electrolytes, glucose levels Correct haematological derangements- blood, platelets, clotting factors- fresh frozen plasma, exchange transfusion Enteral feeds are withheld in an unstable infant Hygiene: Hand washing by staff and parents Use of sterile equipment and protective equipment Frequent changing of catheters, IV lines, urine bags Sterilizing stethoscope between patients Early Benzylpenicillin 60mls/kg 12hrly, if meningitis suspected 120mg/kg/dose 12hrly Gentamicin 5mg/kg IV 36hrly if >1200g, 48hrly if <1200g Late onset: onset: Vancomycin 15mg/kg 18hrly for term babies Gentamicin 5mg/kg36hrly for term babies <7days, 24hrly if >7days Flucloxacillin 25mg/kg/dose 12hrly for preterm babies Definite treatment dictated by organisms grown at blood culture where present or to be guided by bacterial pattern in the unit Hand washing by staff and parents Use of sterile equipment and protective equipment Frequent changing of catheters, IV lines, urine bags Sterilizing stethoscope between patients Minimize contact with the baby