Neonatal sepsis

Neonatal sepsis
Specialty	Pediatrics

In common clinical usage, neonatal sepsis specifically refers to the presence of a serious bacterial infection (SBI) (such as meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of fever. Criteria with regards to hemodynamic compromise or respiratory failure are not useful clinically because these symptoms often do not arise in neonates until death is imminent and unpreventable.

It is difficult to clinically exclude sepsis in newborns less than 90 days old that have fever (defined as a temperature > 38°C (100.4°F). Except in the case of obvious acute viral bronchiolitis, the current practice in newborns less than 30 days old is to perform a complete workup including complete blood count with differential, blood culture, urinalysis, urine culture, and cerebrospinal fluid(CSF) studies and CSF culture, admit the newborn to the hospital, and treat empirically for serious bacterial infection for at least 48 hours until cultures are demonstrated to show no growth. Attempts have been made to see whether it is possible to risk stratify newborns in order to decide if a newborn can be safely monitored at home without treatment despite having a fever. One such attempt is the Rochester criteria.

Risk factors

A study performed at Strong Memorial Hospital in Rochester, New York, showed that infants ≤ 60 days old meeting the following criteria were at low-risk for having a serious bacterial illness:

• generally well-appearing
• previously healthy
  • full term (at ≥37 weeks gestation)
  • no antibiotics perinatally
  • no unexplained hyperbilirubinemia that required treatment
  • no antibiotics since discharge
  • no hospitalizations
  • no chronic illness
  • discharged at the same time or before the mother
• no evidence of skin, soft tissue, bone, joint, or ear infection
• WBC count 5,000-15,000/mm³
• absolute band count ≤ 1,500/mm³
• urine WBC count ≤ 10 per high power field (hpf)
• stool WBC count ≤ 5 per high power field (hpf) only in infants with diarrhea

Those meeting these criteria likely do not require a lumbar puncture, and are felt to be safe for discharge home without antibiotic treatment, or with a single dose of intramuscular antibiotics, but will still require close outpatient follow-up.

Diagnosis

neonatal sepsis screening:

1.DLC showing increased numbers of polymorphs. 2.DLC: band cells> 20% 3.increased haptoglobins 4.micro ESR titre: >55mm 5.gastric aspirate showing > 5 polymorphs per high power field. 6.newborn CSF screen: showing increased cells and proteins. 7.suggestive history of chorioamnionitis, PROM, etc...