Sepsis

Sepsis occurs at a rate of about one case per 1000 live births, and one-third of septic newborn babies develop meningitis. Factors associated with perinatal infection are either maternal or perinatal. Premature rupture of membranes, prolonged rupture of membranes, and maternal infection presenting as chorioamnionitis or urinary tract infection increase the likelihood of newborn disease. Low birth weight is the single most important risk factor for the infant. Group B b-hemolytic Streptococcus most frequently causes newborn sepsis and meningitis. E. coli is second in prevalence, and Lysteria monocytogenes and Haemophilus influenzae are other pathogens.

Infants often present with subtle and nonspecific findings. Ninety percent of sepsis infants have respiratory distress in the form of apnea, rapid respirations, grunting, nasal flaring, and cyanosis. Temperature instability, decreased activity, metabolic acidosis, low blood pressure, bruising, abdominal distention, ileus, diarrhea, lethargy, and seizures alone or in combination are manifestations of newborn sepsis.

Blood and cerebrospinal fluid samples should be cultured and evaluated for total and differential white blood cell counts, serum glucose level, and cerebrospinal fluid protein. Urinalysis has not been helpful in the management of neonatal sepsis. All infants suspected of being septic should be admitted to the hospital. Ampicillin and cefotaxime concomitantly and each at a dose of 50 to 100 mg/kg q 8 to 12 h will provide the broadest coverage until the organism and antibiotic susceptibility have been determined.

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