Neonatal Infections

NEONATAL INFECTIONS,
NOENATAL SEPSIS,
OPTHALMIA NEONATRUM &
CONGENITAL SYPHILLIS
Dr. Jayesh Patidar
www.drjayeshpatidar.blogspot.com
Anti microbial selection
1. E.Coli, Klebsiella, Shigella & Salmonella :
Amnioglycorides or 3rd generation Cehalosponis.
2. Haemophilus Influenza : Ampicillin & 3rd generation
Cehalosponis. Sometimes ampicillin are resistant.
3. Pseudomonas : Amnioglycorides + anti pseudomonas
pencillin.
4. Bacteroides Fragilis : Metronidazole, clindamycin,
some beta lactomoses such as imipenum & ampicillin
with sulbactim & chloramphenicol.
9/17/2014 2 www.drjayeshpatidar.blogspot.com
Group B Streptococcus
Group b streptococcus hemolytic streptococci were
unknown to the perinatal scene until there early
1970s where they replaced E.Coli as the single most
common agent associated with bacterial meningitis
during the 1st 2 months of life.
Pathophysiology
Intensity of the maternal colonization is directly
Related to risk of invasive disease in the neonate
because of low & high density colonization
Risk of amniotic fluid contaminated with meconium
or vernix caseosa which promotes the growth of
the GBS & E.Coli
Conts.
Few organisms in the vaginal vault due to the PMOM
Possibly contributing to the paradox.
Organisms usually reach the blood stream by fetal
aspiration or swallowing of the contaminated amniotic
fluid
Leading to bacteremia.
Escherichia Coli
E.Coli is a gram negative, non spore forming
motile rod. It is a normal inhabitant of the
gastro intestinal tract & most common cause
of the gram negative infection in the new
born.
Listeria Monocytogenes
1. It is found in the birds & mammals, including domestic
and farm animals.
2. It is found in the unpasteurized milk, soil and fecal
matter.
3. The infection appears to be undiagnosed and an
underreported cause of the congenital infection.
Neonatal meningitis
A neonatal bacterial meningitis is the
inflammation of the meninges due to
the bacterial invasion. Meningitis can
be a sequence of the new born
infection. 9/17/2014 8 www.drjayeshpatidar.blogspot.com
Toxoplasmosis
The importance of the parasite
toxoplasma gondii was discovered by
health care worker through the
perinatal death.
Management
1. Prevention & early recognition.
2. Mother at a risk should avoid soil digging, handling
or cooking under cooked meat.
3.If the signs of infection exhibit then report
immediately.
4.Congenital toxoplasmosis : Pyrimethamine +
Sulfonamides. 2mg/kg/day, orally for 2 days,
followed by 1mg/kg/day for 2 or 6 months, then
1mg/kg/day every Monday, Wednesday and Friday
for a year period.
Conts
5.Doses of 100mg/kg/day is divided into 2 doses for 1 year.
6.Levovorin 10 mg is given 3 times weekly & for 1 week after
Pyrimethamine therapy.
7.Corticosteroids are given in the form of predinose at 1
mg/kg/day in 2 divided doses until there is a resolution of
elevated protein in CSF.
RUBELLA
Congenital rubella is a viral infection
acquired from the mother during
pregnancy. It has been established
that the rubella virus can be
responsible for other abnormalities.
Management
1.Avoid pregnancy for atleast 2 months after
immunizations to decrease the risk of rubella
syndrome.
2.If the women receives rubella or RHoGAIG (RhIG).
The vaccine may not trigger an immune response
because blood products & RHoGAIG have pooled
sera that may contain antibodies against rubella.
Thus the women does not produce antibodies.
3.Trites should be drawn between 6 weeks after the
vaccination or at most after 3 weeks.
Conts.
4.Vaccination is not recommended in
pregnancy but in case if they dont wish to
continue the pregnancy they go for the
vaccination.
5.Avoid contacts with the patients.
6.Follow up for the children for the cardiac
problems & cataracts should be done.
Cytomegalo virus
Infection with cytomegalovirus, a member of
the herpes family, is common. CMV is a DNA
virus covered with a glycoprotein coat that
closely resembles the herpes & varicella
zoster virus. CMV infection is more prevalent
in lower economic group & especially
common in the developing countries.
HERPES SIMPLEX VIRUS
Introduction
Neonatal herpes simplex virus infection is
usually transmitted during delivery. HSV is a
member of a family of the large DNA virus.
They contain linear, double strands of DNA.
The herpes family also includes CMV,
Varicella-Zooster & Epstein-Barr Virus.
Management
1. Antiviral drug: Acyclavir & Vidarabine.
2. Vidarabine: 15-30mg/kg/day/IV, over a period of 10-
14 days for 12 hours.
3. Acyclavir: 30mg/kg/day/IV divided over 8 hours for 10
to 14 days. it helps in decreasing the reactivation of
the virus particularly in the treatment of herpes
simplex encephalitis.
4.Eye: Trifluridine, 1 drop every 2 hours, as well as IV
therapy.
Others
1.Isolation : viral shedding provides an reservoir
for infecting others.
2.Family education & support.
3.Hand washing techniques.
4.Positive cultures at birth may just reflect
colonization, cultures should be repeated at
24 to 48 hours.
Hepatitis virus
It is a double stranded DNA containing
virus exposure to infected blood & body
fluids, percutaneous introduction of
blood & administration of infected
blood products are the principal routes
of transmission.
Chlamydia
Chlamydia trachomatis infection has
been identified as causing significant
increase in the incidence of PROM,
the number of low birth weight babies
and the rate of infant mortality.
Candida Albicans
It is the more prevalent form in the
neonates. Candida organisms are oval,
yeast like cells that can bud to reproduce
C-Albican producers endotoxican,
hemolysis, pyrogen & protrolytic
enzymes that are damaging to the tissues.
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