INFECTION IN NEONATE

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
streptococcus VZV
CMV Toxoplasmosis - Gram (-) organism Enterovir HIV
Rubella Syphilis - Listeria us Hepatitis B
Parvovirus Malaria monocytogenes Hepatitis C
VZV TB - Coagulase negative HPV
Staph. Aureus HTLV-1
- 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)
-Staphylococcus Aureus -Gram (-) organisms HIV
-Group B Hepatitis B
streptococcus Hepatitis C
-Staphylococcus HPV
Aureus HTLV-1
-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  38ºC
± 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
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/ : Gram’s 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 baby’s 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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