Neonatal Sepsis
We accept risk in paediatrics every day. A 1% risk of missing a diagnosis might be fine on a child with a cough ?pneumonia, but many will see 1% as an unacceptable risk with a febrile neonate - Alasdair Munro & Damian Roland
image by: Emergency Kind
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Its just a virus? Tackling Pediatric Fever
Sepsis is uncommon in the term and late preterm neonates. Its estimated in 5 per 1000 cases, however it is 15% of all neonatal deaths.
Here, we define “term” as >37 weeks. Late preterm is 34-36 weeks. The earlier the gestational age, the higher the rates of neonatal sepsis. For purposes of workup, a late preterm neonate that did not have a complicated post-delivery course (prolonged NICU stay, comorbidities, etc) should be treated the same as a full term neonate.
Neonatal sepsis is defined as an infectious syndrome that occurs at any point during the period of birth to 28 days.
Sources: By far, the most common cause of fever in a neonate is some non-herpetic virus (adenovirus,…
Resources
Step-by-Step Approach to Febrile Infants
We decided to design this tool because we commonly used different biomarkers that were not adequately included in existing protocols, and we wanted to get a good tool to identify young febrile infants suitable for outpatient management.
Neonatal Sepsis: A Brief Visual Guide
Presentations for neonatal sepsis can be vague, varied, and odd. Abnormal vital signs are often not part of the presentation. It can vary from something as subtle as "she just doesn't seem right" to something as ominous as focal seizures.
Can You Avoid Lumbar Puncture in Febrile Neonates?
Controversy exists on this topic. Some providers feel strongly that lumbar punctures should be performed on every febrile infant under 90 days of age. Others, including many pediatricians, feel confident in assessing individual risks and recommending lumbar punctures on a case-by-case basis. (JAMA 2004 10;291[10]:1203.) Neonates under 30 days old are placed in a separate category by most studies.
Fever under 60 days of age
Many of us will be familiar with the mantra that all children under 3 months get a full septic screen and antibiotics. It feels like we are over-treating, but this is a high risk group so is there any other way?
Neonatal Fever v6.0: ED Phase (0-28 days old)
Because the clinical exam alone is unreliable to predict serious illness in this age group, clinicians must rely on a combination of history, physical exam and diagnostics tests to determine a patient’s risk of Serious Bacteria infection (SBI) and balance this risk with the cost and morbidity of empiric treatment.
Serious Pediatric Fever
The febrile neonate is a child 28 days and younger who presents with a fever. These children are at very high risk of serious bacterial infections, including urinary tract infection, pneumonia, meningitis, and bacteremia. Risk factors for serious bacterial infection in a neonate include prematurity, low birth weight, premature or prolonged rupture of membranes, meconium aspiration, or maternal group B streptococcus infection.
Sim Corner: The Sick Neonate
Broad spectrum antibiotics: Ampicillin + Gentamicin OR Ampicillin + Cefotaxime
The Sick Neonate
Neonates are a distinct population with physiological differences. The sick neonate in the ED is uncommon, but terrifying. Having an approach is the most important aspect. Rapid assessment and management is vital.
To LP, or not to LP (the febrile infant): That is the question
Although some practitioners continue to use screening criteria from the 1990s, clinical decision tools are still being created to help identify infants at low risk for SBI. Despite these new tools and evolving medical knowledge, there is still a wide practice variation in the evaluation of febrile infants in the emergency department.
Its just a virus? Tackling Pediatric Fever
Amp/Gent are preferred in the literature due to reports of emerging cephalosporin-resistant organisms. Also, cephalosporins are not active against Listeria. A few studies showed a lower mortality with Gentamicin compared to those treated with cefotaxime.
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