INFECTION IN

NEONATE
Reproductive System
Perinatology Division, Child Heath Department,
Medical Faculty of Hasanuddin University

Infection in neonate
According to timing of

transmission:

Congenital Infection
Neonatal infection

According to severity:
Mild infection
Severe infection Neonatal
Sepsis

NEONATAL INFECTION

CONGENITAL INFECTION

Timing of
transmissio
n

In- utero

Route of
infection

Transplacental

Time of
presentatio
n

At birth or
month/year later

Viral

Others

CMV
Rubella
Parvovirus
VZV

Toxoplasmosis
Syphilis
Malaria
TB

Shortly before or at
delivery or post natally
Transplacental / birth
canal / breastmilk
First few weeks of
life:
-Early onset : <72
h
-Late onset : > 72
h
Bacterial

Viral

- Grouo B
streptococcus
- Gram (-)
organism
- Listeria
monocytogenes
- Coagulase
negative Staph.
Aureus

HSV
VZV
Enterov
irus

Month or years
later
Fung
al

HIV
Hepatitis
B
Hepatitis
C
HPV
HTLV-1

Congenital Infection
May precipitate abortion, stillbirth or preterm delivery
Clinical Features
Head :
Intracerebral calcification
Hydrocephalus
Microcephalus
Eye:
Cataracts
Microphthalmia
Retinitis
Ear : Deafness
Heart defect: Cardiomegaly,

PDA

Pneumonitis
Splenomegaly
Hepatomegaly
Jaundice
Anemia, Neutropenia,
Thrombocytopenia
Bone abnormalities
Rash
IUGR

Diagnosis

ANTENATAL

POSTNATAL

Maternal
- History (rash, contact)
- Screening serology-seroconversion (IgG, IgM, IgA)
- Culture/PCR of lession e.g.cervical herpes, blood, urine
Fetal
-Ultrasound scanning for
anomalies
-Amniocentesis for
serology/culture/PCR

Placenta
-Histologi/microscopic
-Culture/PCR
Infant
- Culture/PCR: blood, urine, CSF,
stool, nasopharyngeal aspirate,
skin lesion

Neonatal Infection
Classification:
Severe Infection Sepsis
Early onset Sepsis (<72 hours)
Late Onset Sepsis (>72 hours)

Mild infection: Skin, eye, umbilical, mouth, etc

NEONATAL INFECTION
Timing of
transmissio
n

Shortly before or at delivery or post

natally

Time of
presentatio
n

Early onset
sepsis (<72
hours)

Route of
infection

Transplacental
Chorioamnionitis
Birth canal

Bacterial
- Grouo B
streptococcus
- Gram (-) organism
-Listeria
monocytogenes
-Staphylococcus Aureus

Late onset
sepsis (>72
hours)
Nosocomial
Birth canal
TERM

PRETERM

- Grouo B
streptococcus
-Gram (-)
organisms

-Coagulase
negative
Staphylococcus
(CONS)
-Gram (-)
organisms
-Group B
streptococcus
-Staphylococcus
Aureus
-Enterococcus

Month or years
later
Birth canal
Nosocomial
Breastmilk

HIV
Hepatitis
B
Hepatitis
C
HPV
HTLV-1

Neonatal
Mortality
Infections 32%
Asphyxia 29%
Complications of prematurity 24%
Congenital anomalies 10%
Other 5%

Case fatality due to neonatal sepsis is 12 to 68% in

developing countries

Neonatal sepsis- morbidity

Brain damage due to

meningitis, septic shock, or

hypoxemia
Other organ damage - lung,

liver, limbs, joints

Early Onset Sepsis - risk factors

Maternal chorioamnionitis
Prolonged rupture of membranes >18 h
Foul smelling amniotic fluid
Handling by untrained midwife
Maternal urinary tract infection
Premature labor

Chorioamnionitis
Maternal fever during labor 38C
uterine tenderness
leucocytosis
fetal tachycardia

High risk of neonatal sepsis

Late Onset Sepsis risk factors

Prematurity/ LBW
In hospital
Invasive procedures- ventilator, IV lines, central

lines, urine catheter, chest tube

Contact with infectious disease - doctors, nurses,

babies with infections,

Not fed maternal breast milk
POOR HYGIENE in NICU

Bacterial Pathogens Responsible for Sepsis in

Developing Countries
Early onset sepsis
Gram negative bacilli

E.coli
Klebsiella

Enterococcus
Group B streptococcus

Late onset sepsis

Gram negative bacilli

Pseudomonas

Klebsiella

Staph aureus
Coagulase negative

staphylococci

Diagnosis of Neonatal
Sepsis
Clinical signs and symptoms
Laboratory tests
culture of bacterial pathogen
other laboratory indicators

Radiologic

Clinical signs and symptoms

Clinical Signs: early signs non- specific, may be subtle
Respiratory distress- 90%
Apnea
Temperature instability- temp more common
Decreased activity
Irritability
Poor feeding
Abdominal distension
Hypotension, shock, purpura, seizures- late signs

Laboratory Tests
Cultures to identify bacterial pathogen
blood, CSF, urine, other

Hematological tests
WBC count (normal 5.000 25.000/uL)
Platelet count (Trombocytopenia < 100.000/mm3)
Erythrocyte Sedimentation Rate (ESR)

Other tests
C- reactive protein

Lumbar Puncture

Possibility of meningitis 1-10%

Babies with meningitis may not have specific symptoms
15% of babies with meningitis will have negative

blood cultures

First line therapy

Ampicillin 50 mg/ kg
every 12 hours in 1st week of life
every 8 hours from 2- 4 weeks

PLUS
Gentamicin once daily.
> 35 weeks gestation: 4 mg / kg every 24 hours
30 - 34 weeks gestation:

0 - 7 days: 4.5 mg/kg every 36 hours

> 8 days: 4 mg/kg every 24 hours

Supportive Care
Temperature support
GI support - vomiting, ileus
Cardiorespiratory support
hypoxia, apnea, ARDS, shock

Hematological support: anemia, thrombocytopenia, DIC

Neurological support- seizures

Prevention of Hospitalized acquired Infection

(Nosocomial Infection)
Hand washing
Early feeding
Maternal breast milk
Decrease use of broad spectrum antibiotics
Decreased use of invasive procedures
Proper sterilization procedures

21

 At first vesicle
Purulent encounter hyperemic area
Multiple severe systemic infection
R/ :
Isolation + aseptic treatment
A.B : Cloxacillin 50 mg/kgBW
Incise the bulla
A.B zalp

R/ topical
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 Infection with Neisseria gonorrheae ( a gram-negative

diplococcus) a reproductive tract infection
transmission to the fetus/ neonate in pregnancy
Clinical presentation :
Hyperemic
Palpebra Edema
Purulent secret
Unilateral/ bilateral
cornea Blind
23

D/ : Grams stain of exudate diplococcus gram (-)

R/ :
Isolation
Eye Topical A.B.
Systemic A.B.

24

UMBILICAL INFECTION
E/ : Staphylococcus aureus
Hyperemic, edema, exudate
Severe lig. falciforme multiple abscess
Chronic granulom
R/ :
Topical : A.B
Granuloma : nitras argenti 3%
25

Oral Thrush
Thrush patches in the babys mouth, lips, tongue
DD/ remain milk easy to remove
E/ fungus : Candida albicans
If

: - immunocompromize
- Using A.B. for long periode

Overgrowth

- Using corticosteroid for long periode

diarrhea +

Moniliasis

Parenteral infection/ sepsis

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D/ : sediaan hapus mycellium + spora

R/ :
Gentian violet 0 5 1 %
Borax glicerin
Nistatin solution 3 x 100.000 U/day
Severe : amphotericin B/ Fluconazol

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