Reproductive System

Perinatology Division, Child Heath Department,

Medical Faculty of Hasanuddin University
Infection in neonate
According to timing of transmission:
Congenital Infection
Neonatal infection
According to severity:
Mild infection
Severe infection Neonatal Sepsis
 CONGENITAL INFECTION NEONATAL INFECTION

Timing of In- utero Shortly before or at delivery or

transmission post natally

Route of Transplacental / birth canal /

Transplacental
infection breastmilk

Time of At birth or First few weeks of

presentation month/year later life: Month or years
-Early onset : <72 h later
-Late onset : > 72 h

Viral Others Bacterial Viral Fungal

- Grouo B HSV
CMV Toxoplasmosis streptococcus VZV HIV
Rubella Syphilis - Gram (-) organism Enterovir Hepatitis B
Parvovirus Malaria - Listeria us Hepatitis C
VZV TB monocytogenes HPV
- Coagulase negative HTLV-1
Staph. Aureus
- Chlamidia
- Gonococcus
 Congenital Infection
May precipitate abortion, stillbirth or preterm delivery
Clinical Features
Head : Pneumonitis
Intracerebral calcification Splenomegaly
Hydrocephalus Hepatomegaly
Microcephalus Jaundice
Eye: Anemia, Neutropenia,
Cataracts Thrombocytopenia
Microphthalmia Bone abnormalities
Retinitis Rash
Ear : Deafness IUGR
Heart defect: Cardiomegaly, PDA
 Diagnosis

ANTENATAL POSTNATAL
Maternal
-History (rash, contact)
-Screening serology-seroconversion (IgG, IgM, IgA)
-Culture/PCR of lession e.g.cervical herpes, blood, urine

Fetal Placenta
-Ultrasound scanning for anomalies -Histologi/microscopic
-Amniocentesis for -Culture/PCR
serology/culture/PCR
Infant
- Culture/PCR: blood, urine, CSF, stool,
nasopharyngeal aspirate, skin lesion
 Neonatal Infection
Classification:
Severe Infection Sepsis
Early onset Sepsis (<72 hours)
Late Onset Sepsis (>72 hours)

Mild infection: Skin, eye, umbilical, mouth, etc

 NEONATAL INFECTION

Timing of
transmission Shortly before or at delivery or post natally

Time of Early onset sepsis Late onset sepsis Month or years

presentation (<72 hours) (>72 hours) later

Transplacental Birth canal

Route of Nosocomial
Chorioamnionitis Nosocomial
infection Birth canal
Birth canal Breastmilk

TERM PRETERM
Bacterial
- Grouo B streptococcus - Grouo B -Coagulase negative
- Gram (-) organism streptococcus Staphylococcus
-Listeria monocytogenes -Gram (-) organisms (CONS)
HIV
-Staphylococcus Aureus -Gram (-) organisms
Hepatitis B
-Group B
Hepatitis C
streptococcus
HPV
-Staphylococcus
HTLV-1
Aureus
-Enterococcus
-Fungal
Neonatal Mortality

Infections 32%
Asphyxia 29%
Complications of prematurity 24%
Congenital anomalies 10%
Other 5%

Case fatality due to neonatal sepsis is 12 to 68% in

developing countries
Neonatal sepsis- morbidity
Brain damage due to
meningitis, septic shock, or
hypoxemia
Other organ damage - lung,
liver, limbs, joints
Early Onset Sepsis - risk factors

Maternal chorioamnionitis

Prolonged rupture of membranes >18 h

Foul smelling amniotic fluid

Handling by untrained midwife

Maternal urinary tract infection

Premature labor
Chorioamnionitis
Maternal fever during labor 38C

uterine tenderness

leucocytosis

fetal tachycardia

High risk of neonatal sepsis

Late Onset Sepsis -
risk factors

Prematurity/ LBW
In hospital
Invasive procedures- ventilator, IV lines, central
lines, urine catheter, chest tube
Contact with infectious disease - doctors, nurses,
babies with infections,
Not fed maternal breast milk
POOR HYGIENE in NICU
 Bacterial Pathogens Responsible for Sepsis in
Developing Countries
Early onset sepsis Late onset sepsis
Gram negative bacilli Gram negative bacilli
E.coli Pseudomonas
Klebsiella Klebsiella
Enterococcus Staph aureus
Group B streptococcus Coagulase negative
staphylococci
 Diagnosis of Neonatal Sepsis

Clinical signs and symptoms

Laboratory tests

culture of bacterial pathogen

other laboratory indicators

Radiologic
Clinical signs and symptoms
Clinical Signs: early signs non- specific, may be subtle
Respiratory distress- 90%
Apnea
Temperature instability- temp more common
Decreased activity
Irritability
Poor feeding
Abdominal distension
Hypotension, shock, purpura, seizures- late signs
Laboratory Tests

Cultures to identify bacterial pathogen

blood, CSF, urine, other

Hematological tests

WBC count (normal 5.000 25.000/uL)

Platelet count (Trombocytopenia < 100.000/mm3)
Erythrocyte Sedimentation Rate (ESR)
Other tests

C- reactive protein
Lumbar Puncture

Possibility of meningitis 1-10%

Babies with meningitis may not have specific symptoms

15% of babies with meningitis will have negative blood

cultures
First line therapy

Ampicillin 50 mg/ kg
every 12 hours in 1st week of life
every 8 hours from 2- 4 weeks

PLUS
Gentamicin once daily.
> 35 weeks gestation: 4 mg / kg every 24 hours
30 - 34 weeks gestation:
0 - 7 days: 4.5 mg/kg every 36 hours
> 8 days: 4 mg/kg every 24 hours
Supportive Care
Temperature support

GI support - vomiting, ileus

Cardiorespiratory support

hypoxia, apnea, ARDS, shock

Hematological support: anemia, thrombocytopenia, DIC

Neurological support- seizures

Prevention of Hospitalized acquired Infection
(Nosocomial Infection)
Hand washing

Early feeding

Maternal breast milk

Decrease use of broad spectrum antibiotics

Decreased use of invasive procedures

Proper sterilization procedures

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 At first vesicle
Purulent encounter hyperemic area
Multiple severe systemic infection

R/ :
Isolation + aseptic treatment
A.B : Cloxacillin 50 mg/kgBW
Incise the bulla
R/ topical
A.B zalp
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 Infection with Neisseria gonorrheae ( a gram-negative
diplococcus) a reproductive tract infection
transmission to the fetus/ neonate in pregnancy

Clinical presentation :
Hyperemic
Palpebra Edema
Purulent secret
Unilateral/ bilateral
cornea Blind
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D/ : Grams stain of exudate diplococcus gram (-)

R/ :

Isolation

Eye Topical A.B.

Systemic A.B.

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 UMBILICAL INFECTION

E/ : Staphylococcus aureus
Hyperemic, edema, exudate
Severe lig. falciforme multiple abscess
Chronic granulom

R/ :
Topical : A.B
Granuloma : nitras argenti 3%

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 Oral Thrush

Thrush patches in the babys mouth, lips, tongue

DD/ remain milk easy to remove
E/ fungus : Candida albicans
If : - immunocompromize Overgrowth
- Using A.B. for long periode
- Using corticosteroid for long periode
Moniliasis
diarrhea +
Parenteral infection/ sepsis
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D/ : sediaan hapus mycellium + spora

R/ :

Gentian violet 0 5 1 %

Borax glicerin

Nistatin solution 3 x 100.000 U/day

Severe : amphotericin B/ Fluconazol

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