Neonatal Infection 2005
-
Upload
dang-thanh-tuan -
Category
Health & Medicine
-
view
978 -
download
4
Transcript of Neonatal Infection 2005
![Page 1: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/1.jpg)
Neonatal Infections
May 2005
Dr Patricia Fenton
Sheffield Children’s Hospital
![Page 2: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/2.jpg)
Neonatal Infections
Hazard analysis at critical control point
A baby production line
Uterus to push chair
![Page 3: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/3.jpg)
The Bad News Is…..
No
Pictures
![Page 4: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/4.jpg)
The Good News Is….
994 out of every 1000 infants born in the
UK survive
![Page 5: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/5.jpg)
Some Definitions
Infant - <1 year
Neonate - < I month
“early onset” - < 7 days
![Page 6: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/6.jpg)
Infant Deaths 93-97 (Number)
0
1000
2000
3000
4000
5000
6000
7000
8000
Congen Infection
E and W figures Neonates account
for 67% of deaths Infection is NOT a
major cause of neonatal death.
![Page 7: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/7.jpg)
A Hazardous Journey
The uterus: Listeria monocytogenes The birth canal: group B streptococcus The unit: Acinetobacter baumanii Devices: CNS The attendants: Staph aureus
![Page 8: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/8.jpg)
Three Barriers to Infection
NORMALFLORA
SKIN ANDMUCOUS
MEMBRANES
IMMUNITY
![Page 9: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/9.jpg)
Impaired Barriers
Thin skin
Raw umbilicus
Invasive devices
![Page 10: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/10.jpg)
Small/premature =
Poor antibody response Poor neutrophil response Poor complement activation Impaired macrophage activity Poor T cell function Reduced placental IgG
![Page 11: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/11.jpg)
Clinical Presentations
Not breathing well Not feeding well Not looking well
lethargic irritable mottled Fever and tachycardia Seizures
AND NOT A BLOOD TEST OR XRAY!
![Page 12: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/12.jpg)
Listeria monocytogenes
1-3 cases per million per year E&W 17 pregnancy associated cases 2001 >300 pregnancy assoc. 87-89
Soft cheese, paté and chilled meals All animals 5% humans in bowel
![Page 13: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/13.jpg)
Listeria - an interesting organism
G + rod Flagellae-RT not BT Tumbling motility Haemolytic BA Invasin (IC) Actin tails Listerioloysin O
![Page 14: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/14.jpg)
Log10 bacteria per ml
0
1
2
3
4
5
6
7
8
9
1 week 2 weeks 3 weeks 4 weeks
4 degreesminus 20
![Page 15: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/15.jpg)
Disease Spectrum
Influenza like illness (maternal) Sepsis with stillbirth
Neonatal sepsis/meningitis
Sepsis/meningitis in impaired immunity (at any age)
![Page 16: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/16.jpg)
Treatment, Outcome and Control
Ampicillin or amoxycillin Plus gentamicin
One third fatal
Avoidance, food quality measures, high level of suspicion, early treatment
![Page 17: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/17.jpg)
Early Onset GBS Disease
376 cases in 2001 39 died
Important because: Identified risk factors Preventable
![Page 18: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/18.jpg)
Risk Factors
Previous baby affected by GBS GBS in urine at any time this pregnancy Preterm labour Prolonged ROM Fever in labour
(RCOG guidelines 2003)
![Page 19: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/19.jpg)
Screening Based Strategy
27% carry it (rectal plus vaginal swabs)
Antibiotic prophylaxis 86% reduction
Treat 1000, prevent 1.4
![Page 20: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/20.jpg)
Risk Factor Strategy
25% women have one or more risk
Antibiotic prophylaxis 69% reduction
Treat 1000, prevent 2
![Page 21: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/21.jpg)
The Disease
Early onset Low apgar Sepsis Pneumonia
GBS causes 70% early onset sepsis Low birth weight
![Page 22: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/22.jpg)
Prevention
Choose your mother carefully (IgG)
Be big (mortality 6% vs. 18%)
Penicillin AT ONSET OF LABOUR
![Page 23: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/23.jpg)
Christmas Day HH
Premature 35/40 No ANC Septic, ventilated Extubated day 11 Home “to die”
BUT….
![Page 24: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/24.jpg)
The Unit
24 cots (2x6 bedded 1x12 bedded) Zero to two cases per year for 5 years 4 month period 11 cases clinical sepsis All cases in one 6 bedded ward area
![Page 25: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/25.jpg)
The Bug
Acinetobacter baumannii Gram negative cocco-bacillus Water-dwelling saprophyte Long survival on dry surfaces Mattresses, air con, ventilators Up to 25% normal human skin flora Dissemination via hands?
![Page 26: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/26.jpg)
What Happened Next?
Cultured everything.
![Page 27: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/27.jpg)
Results?
Nothing
Followed each baby and everything that happened to them
![Page 28: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/28.jpg)
And they found
Hydrocolloid dressings-large sheets Cut and stored Used on skin
CULTURE POSITIVE OUTBREAK STRAIN
![Page 29: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/29.jpg)
What happened next?
Practice stopped Outbreak ended
3 babies died
![Page 30: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/30.jpg)
Lessons Learnt
A knowledge of background infection rates useful (none to 11)
Susceptible patients are just that
Plastic wallets make good incubators
![Page 31: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/31.jpg)
Devices
Initial response Getting worse
Central line in situ ?CNS
![Page 32: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/32.jpg)
Coagulase negative staphylococci
Gram positive cocci Normal skin flora Low grade pathogen in normal host Hydrophobic cell surface (adheres) Polysaccharide production - biofilm Neonatal infections
![Page 33: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/33.jpg)
Neonatal Unit B/C
CNS 234 Stau 17 E.coli 19 GNB’s 32 GBS 18
![Page 34: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/34.jpg)
Attendants
6 week period 4 blistered babies Early discharge 14 more identified
Staph aureus Phage type 3A/3C Exfoliative toxin A
![Page 35: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/35.jpg)
Outbreak Control
Swabs of all staff handling newborns Check all hands
One individual handled 17/18 affected Epidemic strain from nose, axilla, peri All other staff negative Treatment of carrier ended outbreak
![Page 36: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/36.jpg)
Staphylococcus aureus
Looks like CNS and.. Normal flora (30% adults) but.. Highly pathogenic Exfoliative toxin A - SSSS Potential for cross infection
Treated with flucloxacillin
![Page 37: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/37.jpg)
Control Measures
Wash hands
and
check hands
![Page 38: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/38.jpg)
Conclusions
Infection: significant hazard to neonate Journey womb to push chair Bacteria for every occasion
Smaller is frailer Never give up on a neonate
![Page 39: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/39.jpg)
Our Aim at SCH
Family focused service
Putting the needs and welfare
of children first
![Page 40: Neonatal Infection 2005](https://reader035.fdocuments.net/reader035/viewer/2022070313/554ae5dfb4c905a37c8b511b/html5/thumbnails/40.jpg)