Description
define labour. 3 paragraphs
Explanation & Answer
Attached.
NEONATAL SEPSIS
Definition
Systemic response to infection in the newborn.
The term should be reserved for documented infection in a newborn who has systemic illness
for which non-infectious causes have been excluded.
Epidemiology
Neonatal sepsis occurs in from 0.5 to 8.0/1000 live births
Developing countries 6-23/1,000 live births
The highest rates occur in low-birth-weight (LBW) newborns, those with depressed
respiratory function at birth, and those with maternal perinatal risk factors.
The risk is greater in males (2:1) and in newborns with congenital malformations, particularly
of the GU tract.
Classification
1) Early onset sepsis
Onset within 1st to 3 days
Bacteria acquired before and during delivery (GBS + Gram –ve enteric bacteria esp E.
coli)
2) Late onset
Onset after 3rd day of life
Bacteria acquired after delivery (Nosocomial or community) (Staph aureus)
Predisposition
Why are newborns so prone to infection?
Inefficient immune mechanisms;
1) Cellular immunity is compromised Polymorph function is ↓vis adherance, chemotaxis,
phagocytosis
2) Humoral immunity is deficient
IgG crosses placental barrier in 3rd trimester…preterms have very little. IgG useful
defense against gram +ves
IgM….Doesn’t cross placental barrier important defence against gram –ve hence
newborns prone to gram-ve sepsis.
IgA…..Doesn’t cross placental barrier production starts at age 2-5 weeks present in breastmilk responsible for mucosal immunity
Other immune factors e.g. compliment, fibronectin etc are also low.
Physical barriers……SKIN thin and friable- easily breached. …….Mucous membranes
breached by many invasive procedures have no IgA.
Risk factors
a) Maternal perinatal
Chorioamnionitis (esp. with fetal tachycardia)
Prolonged/premature rupture of membranes (18 hours)
Maternal bleeding (placenta previa, abruptio placentae)
Toxemia
Precipitous delivery
Maternal infection (urinary tract or endometrium, most commonly manifested as
maternal fever shortly before or during parturition).
Maternal GBS colonisation
Intrapartum asphyxia
> 6 digital vaginal exams during labor with PROM
Poo...
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