Name Matric Number
Mercy Binti Kalu ADMW1/2020(K)0174
Moinis Binti Kurutok ADMW1/2020(K)0175
Norain Binti Awang ADMW1/2020(K)0178
Nordayana Binti Yunus ADMW1/2020(K)0179
Norheiza Binti Mohd. Benedict ADMW1/2020(K)0180
LEARNING
OBJECTIVES
01 TYPES OF NEONATAL INFECTIONS
02 ETIOLOGY OF NEONATAL INFECTION
03 CLINICAL MANIFESTATION OF NEONATAL INFECTIONS
04 INVESTIGATION OF NEONATAL INFECTIONS
INTRODUCTION
INFECTION
Ø Increasing problem in the sick and
vulnerable neonate
Ø Predisposition lies in the reduced immune
defences of the neonate – both specific and
non-specific immunity
Ø Specific immunity involves the action of
immunoglobulins (IgG, IgA and IgM) and T
lymphocytes
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
DEFINITION
NEONATAL INFECTION NEONATAL SEPSIS
- Neonatal infections can occur in - Refers to harmful bacteria or toxin
intrauterine life or during delivery or being present in the neonate. The
in neonatal period. Invasion and neonatal time period is defined as any
uncontrollable growth of pathogenic infant less than four weeks old. This
microorganisms in the body of includes infants born prematurely.
neonate. - Clinical syndrome of systemic illness
accompanied by bacteraemia
occurring in the first month of life.
Skims Soura . (2017, October 03). Neonatal Sepsis: Definition,
Neonatal infections. Causes & Types. (2017, May 26).
TYPES OF
NEONATAL INFECTION 01
TYPES OF INFECTION
Classified according to when acquired
Ø 3 types of neonatal infection:-
1) Intrauterine (Congenital) TORCH
2) Intrapartum (up to 1st week)
3) Post-natal (nosocomial) – from 7
days of life
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
TYPES OF INFECTION
1) Intrauterine (Congenital) TORCH
T – Toxoplasma
O – Others – syphilis, Hep B, Coxsackie, EBV,
Varicella Zoster ,Human parvovirus
R – Rubella
C – Cytomegalovirus
H – Herpes Simplex
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
TYPES OF INFECTION
2) Intrapartum (up to 1st week)
Ø Group B streptococcus is the most common
(Bedford-Russell & Plumb, 2006)
Ø 60% is early onset
Ø 20% fatal (when there is septicaemia)
Ø Mimics RDS, collapse / shock, grunting, apnoea
Ø Treated with penicillin
Ø Other types – Listeria and Herpes
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
TYPES OF INFECTION
3) Post-natal (nosocomial) – from 7 days of life
Ø Nosocomial infection
Ø Staphylococcus – most common plus gram-negative
bacteria (E Coli)
Ø Viral
Ø Fungal
Ø Meningitis
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
ETIOLOGY/CAUSE OF
NEONATAL INFECTION 02
ETIOLOGY OF NEONATAL
INFECTION
Cause of infection can be : -
1. Bacterial
2. Non bacterial
qTORCH
qVIRUS – HIV, Hepatitis, Varicella Zoster
qChlamydial
qCongenital Rubella Syndrome
qHeart problem,
qMental retarded
qETC.
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
BACTERIAL – CAUSETIVE ORGANISMA
Ø Group B streptococcus(GBS)
Ø Gram negative enteric – Escherichia Coli, streptococci,
anaerobes, H. influenza
Ø Gram negative rods-Pseudomonas, Klebsiella Serratia,
Proteus
GBS, Gram – ve enteric around perineum area
Gram – ve rods: community or organism, normally sensitives to penicillin
Dark Blue – positive
Pink - negative
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
03
CLINICAL
MANIFESTATION OF
NEONATAL INFECTION
CLINICAL MANIFESTATION NEONATAL INFECTION
Can be identify as :-
1) Focal or systemic
2) Mild, moderate or severe
3) Acute, subacute or chronic
4) Baby may be lethargic, poor sucking or
irritable.
5) Asymptomatic, LBW, Weight loss, Failure
to thrive, thrombocytopenia
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
CLINICAL MANIFESTATION NEONATAL INFECTION
Fever
ü Only 50% of infected newborns have fever > 37.8oC and
not all newborns with fever signify infection.
ü Fever in newborn can be due to dehydration, increase
room temperature.
ü A fever sustained over >1 H is more likely due to
infection. Usually febrile infected baby also has other
signs of infection even though no obvious focal or organ
involvement.
ü Premature baby may show hypothermia and
temperature instability.
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
CLINICAL MANIFESTATION NEONATAL INFECTION
Rash
ü Macular lesions - cellulitis, omphalitis,
ü Ecthymas Gangrenosum - pseudomonas
infection,
ü Vesicular Rash - herpes virus infection,
ü Satellite Lesions - Candida albicans,
ü Ring worm - tinea capitis,
ü Purple papulonodular lesions (blueberry-
muffin)-congenital viral infections (CMV,
rubella, Parvovirus). Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
CLINICAL MANIFESTATION NEONATAL INFECTION
- FOCAL INFECTION
Omphalitis Pneumonia
-Lower airway infection causing
-Is due to inadequate care of the
inflammation in the lung, introduce
umbilical cord. Infection may
fluid into the airspace.
spread into the abdominal wall,
-Early signs-non-specific, poor
liver, peritoneum and often results
feeding, lethargy, irritability, poor
necrotizing fasciitis and sepsis.
color, temperature instability.
-Starts with erythema and
-Cough, tachypnoea, recession, nasal
induration surrounding the
flaring, cyanosis, apnea.
umbilical stump.
Physical signs: crepitations, rhonchi,
reduced air flow. Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
CLINICAL MANIFESTATION NEONATAL INFECTION
- OPHTHALMIA NEONATORUM
Ø Neonatal conjunctivitis is due to Neisseria
gonorrhoeae (2-5days), Staphylococcus
aureus (1 week)and Chlamydia trachomatis
(1-3 months)
Ø Eye discharge and inflammation.
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
CLINICAL MANIFESTATION NEONATAL INFECTION
- URINARY TRACT INFECTION
Ø 1% in term infant, 10% in preterm infant.
Ø Boy > girl in neonates.
Ø Symptoms: nonspecific, fever, vomit,
diarrhea, hematuria.
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
CLINICAL MANIFESTATION NEONATAL INFECTION
- SYSTEMIC INFECTION
General Fever, temperature instability, inactive, poor feeding
Cardiovascular Pallor, mottling, cold, tachycardia, hypotension, bradycardia
Respiratory Apnea, tachypnoea, recession, grunting, flaring, cyanosis
Gastrointestinal Abdominal distention, vomiting, hepatomegaly, diarrhea.
Renal Oliguria
Hematology Jaundice, pallor, splenomegaly, petechia, purpura, bleeding
Irritability, lethargy, tremors, seizures,hypotonia, hyporeflexia,
Central nervous abnormal Moro’s reflex, irregular breathing, full fontanelle, high
pitched cry. Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
CLINICAL MANIFESTATION NEONATAL INFECTION
- HIV & AIDS
ü Recurrent bacterial infections, chronic parotid
Ø Maternal infant swelling, lymphocytic interstitial pneumonitis
transmission – vertical (LIP) and early onset of progressive neurologic
transmission deterioration.
ü Overall progression of disease is more rapid.
1) Intrauterine : 25-40% ü Recurrent invasive bacterial infections
2) Intrapartum : 60-75% ü Disseminated CMV, Candida, Herpes Simplex
3) Breast feeding : 12- and Varicella Zoster.
14% ü CNS infections are common.
ü Peripheral neuropathy and Myopathy
Investigation
2 positive HIV Antibody Tests ;> 18 month old
2 positive HIV PCR Tests :< 18 month old
Pollymelius Chain Reaction (PCR)
Julia Petty. University of Hertfordshare
(2019). Neonatal Infection.
INVESTIGATIONS OF
NEONATAL INFECTION 04
INVESTIGATION
Investigation of neonatal infection and sepsis is made from
evaluation of the :-
1) Maternal History,
2) Physical Examination and
3) Laboratory Investigations.
Nathan S Gollehon,
Neonatal Sepsis Clinical
Presentation: History,
Physical Examination. (2019,
November 13)
PHYSICAL
EXAMINATION
Ø To obtain the most information from the examination,
systematic physical assessment of the infant is best
performed in a series that should include observation
head to toe, auscultation, and palpation, in that order.
Ø Changes in findings from one examination to the next
provide important information about the presence and
evolution of infection and sepsis.
Nathan S Gollehon, Neonatal Sepsis Clinical Presentation:
History, Physical Examination. (2019, November 13)
LABORATORY INVESTIGATION
Laboratory studies used to evaluate for early-onset and late-onset sepsis include a complete
blood cell (CBC) count and differential, measurement of levels of C-reactive protein (CRP) and
other infection markers. Culture of blood, urine, and cerebrospinal fluid (CSF) samples remains
the gold standard.
Neutrophil count
White cell count <1000
< 5000 OR > 25000
Blood Arterial
culture Blood Gas
Urinalysis Lumbar
-3days old
CRP & PCR TESTING
Julia Petty. University of Hertfordshare
Puncture
(2019). Neonatal Infection.
IMAGING STUDIES
Imaging studies employed in the workup of neonatal
sepsis should target the neonate's symptoms
and may include :-
ü chest radiography to evaluate pulmonary
involvement, as well as
ü computed tomography (CT) scanning,
ü magnetic resonance imaging (MRI), and
ü ultrasonography of the head in cases of
meningitis.
Nathan S Gollehon,
Neonatal Sepsis Clinical
Presentation: History,
Physical Examination. (2019,
November 13)
CONCLUSIONS
Antenatal, intrapartum and postnatal infection can have a
devastating effect on the developing fetus or newborn
baby. Most common infections can be effectively treated if
identified early and appropriate antibiotic therapy initiated
in a timely manner. Utilizing a newborn early warning
observation system in at-risk infants increases the
midwife's ability to detect early and subtle signs of
infection.
(MacDonald, T. & Johnson, G, 2017)
THANKS
Any question?
RESOURCES
Neonatal Sepsis: Definition, Causes & Types. (2017, May 26). Retrieved from [Link]
[Link].
Skims soura Follow. (2017, October 03). Neonatal infections. Retrieved July 13, 2020, from [Link]
infections-80421334
Julia Petty. (2019). Neonatal Infection. Retrieved July 13, 2020, from
[Link]
Tesini, B., By, & Last full review/revision Jul 2018| Content last modified Jul 2018. (2018, July). Overview of Neonatal Infections - Pediatrics.
Retrieved July 13, 2020, from [Link]
infections
MacDonald, T. & Johnson, G. (2017). Mayes' Midwifery. Amsterdam . [Link] from
[Link]
Nathan S Gollehon, Neonatal Sepsis Clinical Presentation: History, Physical Examination. (2019, November 13). Retrieved July 13, 2020, from
[Link]
