SERIOUS BACTERIAL INFECTIONS AND MENINGITIS

Clinical Features

  1. There may be history of;
    • Maternal fever
    • Prolonged rupture of membranes
    • Foul smelling amniotic fluid.
  2. There may be;
    • Danger signs
    • Deep jaundice
    • Abdominal distension
    • Extensive septic skin lesions.

Note: Up to 30% of neonates with late onset sepsis will have meningitis without the obvious features of bulging fontanelle or neck stiffness.

Investigations

  • Full blood count; ask for a film and count of immature neutrophils. An immature to total ratio of >0.2 signifies infection.
  • C-reactive protein (CRP) if available very useful for early diagnosis
  • Blood culture
  • Lumbar puncture
  • Pus swab of any obvious septic area, e.g., umbilicus, skin

Management

Admit the child.

Supportive Care for All Babies
  1. Thermal environment:
    • Keep dry and well wrapped; you may need extra heat either heating the room or keeping baby in incubator according to size of the baby (minimum room temperature 26oC).
  2. Fluid/nutrition:
    • Encourage breastfeeding if the baby is able or otherwise feed by tube. Volumes will depend on baby’s weight and age.
    • If not able to tolerate enteral feed, then give IV fluid. On day 1 give 10% dextrose. Thereafter give maintenance electrolytes. Parenteral nutrition should be considered if baby is starving for longer than 3–4 days.
  3. Oxygen therapy:
    • Give oxygen by nasal prongs or nasal catheter as needed. Do pulse oxymetry if available to monitor saturation. Oxygen can be discontinued once baby has saturations >90% in room air.
  4. High fever:
    • Avoid antipyretics; control the environment instead. Uncover the baby for short period then cover. If baby is in incubator reduce temperature.
  5. Convulsions:
      • Control if present; see section under convulsions.
Management –Specific
  • Give IV penicillin and gentamicin; use cloxacillin instead of penicillin if there are skin lesions.
  • If not improving in 2–3 days, change to second line: ceftazidime or ceftrioxone with amikacin OR according to sensitivity of isolated organism
  • Duration of therapy: depends on response can be 7–14 days of parental therapy. For meningitis treat for 21 days

COMPLICATIONS OF MENINGITIS

The following neurological sequelae occur:

  • Hydrocephalus
  • Blindness
  • Mental retardation
  • Hearing loss
  • Motor disability
  • Abnormal speech patterns

Prevention

The following preventive measures are important:

  • Increased and improved prenatal care.
  • Clean and atraumatic delivery.
  • Regular cleaning and decontamination of equipment.
  • Sound hand-washing principles by all personnel handling babies.
  • Regular surveillance for infection.
  • Early exclusive breastfeeding.