patho of neonatal sepsis

  1. hi all

    i just wanted to ask some help regarding how to make a simple pathophsiology of neonatal sepsis... any input is very much welcome... thanks! i really am lost when it comes to making these...
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  2. 1 Comments

  3. by   VickyRN
    Welcome to AllNurses

    From my nursing lecture notes (hope this helps):

    Sepsis Neonatorum--A severe bacterial infection that spreads through the infant's bloodstream in the first month of life.


    Incidence: Fewer than 1% of newborns, but is responsible for 30% of all neonatal deaths. Higher incidence in preterm and LBW babies.

    Etiology: Exposure to infection in utero, during labor and birth, or after birth. Most common: Group B -hemolytic streptococci (GBS) and Escherichia coli (E-coli).

    Risk factors: Prolonged rupture of membranes, prolonged labor, foul-smelling amniotic fluid.

    Altered Physiology: Newborns are more susceptible to infection due to immune system immaturity (slower reaction to invading organisms); poor localization of infection that allows more extensive spread of infection; less effective blood-brain barrier.

    Clinical Picture (needs to be detected and treated promptly):
    • Signs of infection are often subtle.
    • Temperature instability (low temperature usually first sign).
    • Respiratory problems (especially apneic spells)
    • Changes in feeding habits (poor feeding, spitting up)
    • Changes in behavior (lethargy)
    • Unstable blood glucose levels (high or low)
    • Bradycardia
    • Mottled skin tone
    • Sudden development of septic shock, petechiae, purpuric rash (want to intervene early to prevent this)
    • High risk of mortality

    Diagnostics:
    • CBC with diff (decreased neutrophils, increased bands, decreased platelets)
    • Positive blood, cerebrospinal, urine cultures
    • Drug level tests for antibiotics (peak and trough)

    Therapeutic Management/ Nursing Interventions:
    • Obtain pan cultures (blood, urine, respiratory secretions, stool)
    • IV broad-spectrum antibiotics and antiviral (usually IV gentamicin, ampicillin, acyclovir until culture results)
    • IV immunoglobins
    • Supportive care: oxygen, mechanical ventilation, fluids
    • Keep close track of laboratory results and trends (culture and sensitivity results; WBC's, neuts, bands)
    • Prevent spread of infection (strict asepsis, handwashing, separation of infant's supplies, contact and/or droplet isolation)
    • Support parents

    Question:
    The nurse notes that a 24-hour-old infant is lethargic and his temperature is below normal, a change from an earlier assessment that was normal. Her mother states that she did not breast-feed well and that she spit up the small amount she had ingested. The nurse's next action should be:
      • Reassure the mother that infants are often sluggish this soon after birth.
      • Feed the infant formula to determine accurately how much intake she is getting.
      • Determine whether there is jaundice over the thoracic and abdominal areas.
      • Assess for signs of sepsis and report assessments to the physician.

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