NEONATAL SEPSIS

1. DEFINISI
a systemic bacterial, viral, or fungal infection that poses a potentially fatal threat to both term
and preterm infants
2. EPIDEMIOLOGY
4 to 22 newborns per 1000 live births globally
RISKESDAS 2007  1,8 – 18/1000 kelahiran bayi
3. RF

4. KLASIFIKASI
a. Early onset
- infection acquired by vertical acquisition of a pathogen from mother to neonate that
presents between birth and 72 hours of life
- lebih ke maternal RF
- common pathogen :
o 70% GBS & E.Coli
o Preterm 50% e.coli, 20% GBS
o Term 40-45% GBS, 10-15% e.coli
o Less common  Streptococcus pneumoniae, Staphylococcus aureus,
Enterococcus spp., gram-negative bacilli (Enterobacter spp. and Haemophilus
influenzae), and Listeria monocytogenes.
o Polymicrobial infections are rare.
b. Late onset
- presents after 72 hours of life, and is typically acquired horizontally from the neonate’s
environment, though it can result from a delayed presentation of vertically acquired
maternal pathogens.
- Because of the more common horizontal acquisition, LOS is often considered a hospital-
acquired infection
- Lebih ke neonates RF (premature, VLBW, congenital anomalies)
- Common pathogen :
o Gram + paling banyak
 coagulase-negative staphylococci (50% of cases), S aureus (7% of cases),
and GBS (1% of case)
o gram –
 E coli, Klebsiella pneumonia, Serratia marcescens, Enterobacter spp.,
and Pseudomonas aeruginosa
o Fungal
  Biasa menyerang VLBW
 Candida albicans, candida parapsilosis
o Virus
 Herpes simplex
5. PATHOGENESIS & PATHOPHYSIOLOGY
6. DIAGNOSIS
- HT&PE
Kriteria a >=2 atau kriteria b >=3

-
 - Lab

7. MANAGEMENT
- Broad spectrum
a. Injection Ampicillin 150 mg/kg/every 12 hours + Gentamicin 3–4 mg/kg/every 24
hours selama 10-14 hari
b. In the context of strong clinical suspicion for severe sepsis or gram-negative
meningitis, a third-generation cephalosporin, often cefotaxime, can be added to the
empiric regimen

**Antibiotics should be discontinued by 36 to 48 hours in a well-appearing infant with

negative blood cultures

- Narrowed
 - Supportive therapy
o Supportive therapy and management of complications are continued as needed,
e.g. mechanical ventilation for RDS, dopamine for hypotension, anticonvulsant
for seizures and sodium bicarbonate for metabolic acidosis (p. 546).
o Immunotherapy with IV immunoglobulin (IVIG), monoclonal antibodies,
granulocyte colony stimulating factor (GM–CSF) are used as an adjuvant to the
antibiotic
8. COMPLICATION
- cerebral palsy (16.3%),
- bronchopulmonary dysplasia (53.6%)
- seizures (21%)
- stage 3 or 4 retinopathy of prematurity (22.8%)
- oxygen requirement at discharge (51%)
- cognitive deficits (35.9%)
- visual impairment (13.3%)
- hearing impairment (3.6%) or loss (35%)
- motor delays (27%)

PREMATURE BABY

a.
NEONATES IMMUNE SYSTEM

a. Underdeveloped
b. Skin & barrier function immature
c. Low neutrophil number & inhibited migratory & fagositik ability
d. number of monocytes increases with decreasing gestational age
e. monocyte recruitment and chemotaxis are impaired  a dampened inflammatory response
even in the face of an increased supply
f. monocytes have decreased antigen-presenting abilities
g. Dendritic cells are immature, have decreased expression of various chemical immune regulators,
and are unable to effectively activate an adaptive response
h. Proteins involved in the reactions of the neonatal complement cascade are only 10% to 80% of
normal adult levels, resulting in decreased cellular recruitment, phagocytosis, and cell lysis.
i. Acquired immunity :
- lacks the prior exposure to initiate a memory response due to the sterility of the uterine
environment
- The anti-inflammatory pathway, dampened cytotoxic abilities of CD8+ cells, and the
preferential development of suppressor cells in the neonate reflect the fetus’s need to avoid
an immune response to maternal antigen
- Low Th1
- More plentiful Th2
- Low IgG
- Transplacental acquisition of IgG slowly begins in the second trimester and continues to
term with a surge in the final weeks of gestation, leaving those infants born prior to this
surge of antibodies at an increased risk for infection.