Sepsis (peds)

Background

• Neonatal Sepsis
  • Early onset
    • First few days of life
    • Fulminant, assoc w/ maternal or perinatal risk factors
    • Septic shock and neutropenia are more common
  • Late onset
    • Occurs after 1wk of age
    • Gradual
    • Meningitis more likely

Diagnosis

• Temperature instability (temp >100.4)
• CNS dysfunction
• Respiratory distress
• Feeding disturbance
• Jaundice
• Rash
• Lethargy, irritability, sz
• Apnea, tachypnea, grunting
• Vomiting, poor PO, gastric distention, diarrhea

Work-Up

1. CBC
2. UA/Ucx
3. CXR
4. CSF
5. Blood Cx

Treatment

• Neonatal
  • Ampicillin 50mg/kg + gentamicin 2.5mg/kg + acyclovir
    • If gram-negative strongly suspected replace gent w/ cefotaxime or ceftaz
      • Have better CNS penetration

Disposition

• Admit all neonates

Source

Tintinalli