Peds 2 (neonatal speticemia)
Terms
undefined, object
copy deck
- Neonates are considered immunocomprimised
- True
- neonatal infection can be acquired
- before, during, or after birth
- Risk factors for neonatal infections
-
-maternal intrapartum (during act of birth) infections
-gestational age <37 weeks and low birth weight (<2500 grams)
-prolong rupture of membranes
-traumatic delivery - Definition of newborn septicemia
-
newborns who are <1 month of age, have positive blood cultures, and are ill appearing.
more low birth weight=more risk of infection - most common newborn pathogens for newborn septicemia
-
-group B streptococcal (streptococcal agalactiae, GBS)
-E. Coli
-L. monocytogenes -
antenatal chemoprophylaxis:
recommeded when:
for:
Regimen: -
-antepartum screening at 35-37 weeks of gestation
--> recommended for women with -PMH of previous infant with invasive disease
-positive GBS at antepartum screening
-unknown GBS status
-Ampicillin 2gm iv followed by 1gm q 4h until delivery - Pharmacological therapy of neonatal septicemia
-
-Ampicillin (bactericidal, ae=diarrhea,less common= thrombocytopenia and neutropenia)
-AG (gentamicin, tobramycin, amikacin)-covers E.coli and other enteric gram-negative organisms, and P. aeruginosa -
PK of AG
-serum peak conc. of gentamicin= - -4-12mcg/ml (efficacy=higher peak=more kill)
-
PK of AG
-serum trough conc. - -.5-2 mcg/ml (toxicity)
- AE of AG
- oto and nephro
- when is it necessary to get peak/trough levels?
-
-if treat for >72h
-birthweight <15g
-if renal problem or unstable - never use in neonates because displaces bilirubin from protein
- ceftriaxone (only for meningitis)
- 3rd generation not often used becuase of
-
-resistance
-CNS penetration - 3rd generation cephs (cefotaxime/ceftazidime- bacteriacidal) coverage
- gram neg. organism (no activity against enterococci or L. monocytogenes)
-
empiric regimen (if no prophylaxis)
-->duration of tx -
ampicillin-AG/3rd generation cephalosporin (no meningitis, don't use)
-once sensitivities return, just GBS= can switch ampicillin to penicillin G
-->neg. cultures with clinical improvement=48-72h
-->neg. cultures w/o clinical improvement=7d
-->positive cultures=variable (10-14d)