Antibiotics - for neonatal sepsis
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- Bacterial sepsis is a major problem in the newborn unit.
- The incidence of sepsis is higher in preterm infants, especially the very low birthweight infant (<1500g).
- Common organisms identified are coagulase negative Staphylococci, Staphylococcus aureus, Streptococcus agalactiae (Group B Streptococcus) and Escherichia coli.
- Other important pathogens include Listeria monocytogenes, Streptococcus pneumoniae, Haemophilus influenza and other Gram-negative organisms.
- The clinical presentation of sepsis in the newborn is often non-specific; however, there may be an acute deterioration.
Classification of Neonatal Sepsis
Early Onset Sepsis
Late Onset Sepsis
|Exposure to bacteria can occur:
||Usually due to:
- Antibiotics should be considered in any baby with signs of sepsis, particularly in the presence of risk factors.
- Risk factors may be an indication for investigation but are not in themselves an indication for antibiotics if the baby is born at term and is clinically well.
- If there are any doubts a senior member of staff should be consulted.
Risk factors for Sepsis
- Prolonged rupture of membranes (>18 hours).
- Prematurity (especially in association with PROM).
- Preterm labour with no adequate explanation.
- Fetal distress without adequate explanation (fetal heart rate abnormalities especially fetal tachycardia, passage of meconium).
- Maternal fever or other evidence of infection.
- Foul smelling amniotic fluid or malodorous baby.
- Indwelling vascular catheter.
Signs of Sepsis in the Newborn
- Fever, hypothermia and/or temperature instability.
- Respiratory distress.
- Apnoea and bradycardia.
- Cyanotic episodes.
- Tachycardia, hypotension.
- Lethargy, irritability, poor feeding.
- Unexplained high/low or unstable blood sugars.
- Abdominal distension and bile-stained aspirates.
- Unexplained jaundice.
- Umbilical flare, skin rashes.
What Investigations should be performed?
- Full blood count.
- Differential white cell count (Normal WBC 10-30,000 x 109/L) and percentage left shift (immature neutrophils/total neutrophil count).
- If >20% this is moderately predictive of sepsis.
- A low WCC especially with neutropenia is also suspicious of sepsis.
- Blood cultures.
- Chest radiograph.
- A C-Reactive Protein (CRP) may be indicated. CRP is most useful as a trend, rather than as a diagnostic marker.
- On occasion, skin/wound swabs and (very rarely) gastric aspirate (at birth only).
- CSF may be needed in some cases - discuss with specialist.
The following investigations may need to be considered depending on the organism isolated.
Early onset infection: LP is indicated if the organism is Group B strep or E coli or if infant severely unwell.
Late onset sepsis: In addition to the above consider
- Blood culture taken through central line.
- Lumbar puncture and CSF for microbiology/biochemistry.
- Urine by suprapubic aspirate or catheter.
Antibiotic Use in Suspected Sepsis
First five days
After first five days
|Start amoxycillin and gentamicin for all neonates.||Start flucloxacillin and amikacin in all babies
- Review clinical progress and microbiology results at 36 hours.
- If cultures negative consider stopping therapy.
- Continue therapy if cultures positive or sepsis very likely.
- Add metronidazole if suspicion of anaerobic infection (e.g. intra-abdominal sepsis, NEC). If abdominal infection/NEC beyond 5 days use amoxicillin in preference to flucloxacillin
- Consider vancomycin for coagulase negative Staphylococcal sepsis, especially if infant unwell or central line infection with line staying in. Discuss with specialist first.
- Add cefotaxime if neonatal meningitis. Discuss with specialist first.
- Consider cefuroxime or piptaz for ventilator-associated pneumonia
Duration of Treatment
Duration (days) of therapy
|Urinary Tract Infection||7-10|
|Meningitis||14-21 (depending on organism isolated)|
Did you find this information helpful?
- Date last published: 01 September 2017
- Document type: Clinical Guideline
- Services responsible: Neonatology
- Owner: Newborn Services Clinical Practice Committee
- Editor: Sarah Bellhouse
- Review frequency: 2 years
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