patho of neonatal sepsis

VickyRN, MSN, DNP, RN · Oct 12, 2006

Welcome to AllNurses :balloons:

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 ß-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.