Neonatal Sepsis

The Pocket Book is for use by doctors nurses and other health workers who are responsible for the care of young children at the first level referral hospitals. This second edition is based on evidence from several WHO updated and published clinical guidelines. It is for use in both inpatient and outpatient care in small hospitals with basic laboratory facilities and essential medicines. In some settings these guidelines can be used in any facilities where sick children are admitted for inpatient care. The Pocket Book is one of a series of documents and tools that support the Integrated Managem.

Neonatal sepsis contributes significantly to neonatal morbidity and mortality. The incidence of neonatal sepsis as per National Neonatal Perinatal Database (NNPD 2002-2003) is 30 per 1,000 live births among intramural neonates. Among extramural neonates, sepsis accounts for nearly 40% of admissions to the NICU. It accounts for 18% of neonatal mortality among intramural neonates and nearly 40% of mortality among extramural neonates. The incidence and mortality is much higher in VLBW neonates as compared to term neonates. Neonatal sepsis is a clinical syndrome characterized by systemic signs of infection and accompanied by bacteremia in the first month of life. Once bacteria gains access to the bloodstream, mechanisms are activated by the host to eliminate it. Usually, the bacteria are efficiently cleared by the monocyte macrophage system after opsonization by antibody and complement. Sometimes, however, a systemic inflammatory response syndrome is established and can progress independently of the original infection. In many patients with sepsis, it is difficult to document a bacterial cause. The term "systemic inflammatory response syndrome" includes several stages of infection ranging from sepsis, sepsis syndrome, and early septic shock to refractory septic shock, which can eventuate in multiple organ dysfunction syndrome (MODS) and death. Prevention of sepsis is probably the best management strategy as far as neonatal sepsis is concerned. Strategies include prevention of early-onset sepsis and prevention of late-onset sepsis. For the former, appropriate obstetric care is the key; for the latter, decreasing interventions, promoting breast feeding, and maintaining proper hand hygiene are essential.

Early Onset Neonatal Sepsis is covered in this issue of Clinics in Perinatology, guest edited by Drs. Karen Fairchild and Richard Polin. Authorities in the field have come together to pen articles on Innate host defenses and risk for EONS, Group B streptococcus, Diagnosis and management of clinical chorioamnionitis, Molecular diagnostics of sepsis, Use of proteomics in the diagnosis of chorioamnionitis and neonatal sepsis, Adjunct laboratory tests in the diagnosis of EONS, Ureaplasma: role in diseases of prematurity, Meningitis in neonates, Adjunct immunologic therapies in neonatal sepsis, Pathophysiology and treatment of septic shock in neonates, and International perspective on EONS.

This book is open access under a CC BY 4.0 license. It constitutes a unique source of knowledge and guidance for all healthcare workers who care for patients with sepsis and septic shock in resource-limited settings. More than eighty percent of the worldwide deaths related to sepsis occur in resource-limited settings in low and middle-income countries. Current international sepsis guidelines cannot be implemented without adaptations towards these settings, mainly because of the difference in local resources and a different spectrum of infectious diseases causing sepsis. This prompted members of the Global Intensive Care working group of the European Society of Intensive Care Medicine (ESICM) and the Mahidol-Oxford Tropical Medicine Research Unit (MORU, Bangkok, Thailand) - among which the Editors – to develop with an international group of experts a comprehensive set of recommendations for the management of sepsis in resource-limited settings. Recommendations are based on both current scientific evidence and clinical experience of clinicians working in resource-limited settings. The book includes an overview chapter outlining the current challenges and future directions of sepsis management as well as general recommendations on the structure and organization of intensive care services in resource-limited settings. Specific recommendations on the recognition and management of patients with sepsis and septic shock in these settings are grouped into seven chapters. The book provides evidence-based practical guidance for doctors in low and middle income countries treating patients with sepsis, and highlights areas for further research and discussion.

There are approximately 4 million newborns annually in the United States, including 400,000 infants born preterm. This care occurs in nurseries of all acuity levels, sizes, and regions across the country and is provided by a variety of providers, including pediatricians, family practice doctors, nurse practitioners, and physician assistants. The most common complication during the newborn period is suspected or proven infection – either those acquired during the delivery itself or before delivery in the womb. Indeed, 4 of the 8 most commonly-prescribed medications in newborns annually are antibiotics. Therefore, these providers must all be knowledgeable about the clinical presentation, epidemiology, and approach to diagnosis, treatment and prevention of neonatal infections. However, many of these nurseries do not have convenient access to pediatric infectious disease consultation or support, and would benefit from a convenient reference guide. This book effectively and succinctly covers the pathophysiology, epidemiology, clinical presentation, approach to diagnosis and treatment, and important aspects of preventative care for the most frequently encountered neonatal and congenital infections. The first section discusses common neonatal infections (i.e., those acquired during or after delivery), including sepsis, meningitis, pneumonia, and other focal infections. The second section covers the most frequently encountered congenital infections (i.e., those acquired via the placenta while the fetus is still in-utero). Finally, the concluding section discusses the basics of infection prevention in the nursery setting, including general principles of infection prevention, how to apply those principles to families, and how to manage a suspected outbreak of infection within a nursery. This book is a unique contribution to the field. Existing texts such as the AAP Red Book fold neonatal infections in within chapters on a given pathogen, but the information is difficult to find and access quickly. By covering neonatal and congenital infections thoroughly while still keeping each section clear and concise, this Handbook will be a valuable resource for the busy nursery provider.