NEONATAL SEPSIS During the neonatal period, infection remains a major cause of morbidity and mortality, despite major

advances in neonatal intensive care and the use of broad spectrum antibiotics. Neonatal infections occur in the first week of life and are the result of exposure to maternal genital microorganisms during birth. Neonatal sepsis is a clinical syndrome characterized by the presence of systemic signs of infection accompanied by bacteremia during the first month of life. The early neonatal sepsis is usually presented as a fulminant multisystem disease during the first four days of life. It is the acute infection-systemic toxic manifestations, caused by the invasion and proliferation of bacteria into the bloodstream and various organs that occurs within the first four weeks of life and is proven by positive blood culture. These babies have a history of one or more obstetric risk factors, such as premature rupture of membranes, preterm labor, chorioamnionitis, maternal fever during labor, plus many of these children are premature or low birth weight. The germs responsible are acquired in her birth canal One of the germs responsible for this infection is beta-hemolytic streptococcus which causes severe morbidity and often life-long neurological sequelae. GBS produces two serious infectious processes in the newborn: early-onset disease and late-onset disease. The first has an incidence of 1-4 per 1000 live newborns, is acquired by vertical transmission from colonized mothers and can occur in utero or within 7 days of life, usually in the early hours and is clinically characterized by fetal death , pneumonia, septic shock and neonatal death. Pathogens can contaminate the NB at the skin and /or respiratory or gastrointestinal mucosa and subsequently, according to their characteristics, be divided and be able to penetrate the skinmucosal barrier and reach the bloodstream. Once in the blood, bacteria or fungi can be destroyed by the defenses of the neonate or otherwise continue to divide in logarithmic form and lead to neonatal sepsis. Germs invade the blood from multiple sites, the most frequent in the newborn, respiratory tract, digestive tract, and skin. The most common agents are gram negative pathogens. In order of frequency: y Klebsiella y E. Coli y Pseudomonas y Salmonella y Proteus. Of the Gram positive the most common is Staphylococcus Aureus. In the past 30 years, beta-hemolytic streptococcus group B (GBS) or Streptococcus agalactiae, has become a perinatal pathogen. The diagnosis of neonatal sepsis is difficult to establish based only on clinical criteria, so you have to consider some risk factors as

y y y y y Weight at birth Premature rupture of membranes Maternal GBS colonization Neonatal asphyxia Male newborns It is important to note that there are objective criteria to suspect sepsis such as fever or hypothermia. Supportive therapy includes connecting multisystemic mechanical ventilation. antimicrobial treatment. calcemia and glycemia. renal (water balance. pulse) and evaluation of respiratory function (pulse oximetry. tachycardia. pH. oliguria. monitoring and the ability to deliver multisystem support. tachypnea. renal function tests). urine output. metabolic and coagulation system. plasma electrolytes. altered consciousness. The cornerstones for the cure of the disease are: early diagnosis. the association of vasoactive drugs. It must be handled acute renal failure if it is presented and possible disseminated intravascular coagulation. poor peripheral perfusion and hemodynamic instability The bacterial isolation from a normally sterile body fluid is more specific method for diagnosis of neonatal sepsis. Once stabilized the patient to consider intensive nutritional support to slow catabolism triggered by a severe infection . the use of Plasma Expanders. arterial blood gases). You should maintain a normal metabolic status. The antimicrobial treatment to use depends on the germs involved and the local epidemiology Monitoring should include hemodynamic monitoring (blood pressure.