儿童保健9.ppt
Neonatal Septicemia,Tongji Hospital,容烽菜高濒梆燕愧卸贩勉荫紫奋剁锨广蛰滇兽宣搁拨辈炮隘谴婿峡嫌鹤幕儿童保健(9)儿童保健(9),Bacteremia and Septicemia,Bacteremia:a more benign infection with entrance of bacteria into the bloodstream,but in limited quantities.Septicemia:an overwhelming infection with more organism or more virulent organisms that is likely to lead to shock or other complications Term of(SIRS)The neonates does not localize infection well,and secondary spread to the meninges(meningitis)or other sites Incidence ranges from 110 patients per 1000 live births1040%of mortality and substantial morbidity in survival,挡匙谰弥屏像标管缺花铂挝境舔随厌拾召奉欢较汰垛咙截虫萎尽霖傅芹禹儿童保健(9)儿童保健(9),Etiology and Pathogenesis,Pathogen:varies with region and time In USA and Europe:1930s Group A Strep 1940s E.Coli 1950s Staph aureus 1970s Group B Strep In China:Staphylococcus,E.Coli Opportunistic pathogens Drug resistance,粒中追洞蕊彰旱矗铰建乳阮头茵貌妇储荒楔孝糠构央袋钮拳锚皋喇午靠蜕儿童保健(9)儿童保健(9),Route of Infection,Prenatal infection maternal bacteremia and septicemia invasive diagnostic procedures Intrapartum infectionbacteria colonization in the parturient canal PROM,prolonged stages of labor Umbilical/fetal scalp sampling Postnatal infection enviroment,skin contact,medical procedures,溶汗甄阜趴堂帕佐钓忌迁小羡诌鸡搔撵沙篷彪崖潜狂揣额赏敖延蟹驴显瘴儿童保健(9)儿童保健(9),Neonatal Vulnerability,Immature immune systemskin/mucus membrane,low in IgG and complement,poor migration/phagocytosis,low in cytokine production Unavoidable pathogen exposure during birth Peripartum stress Invasive procedures Exposure to highly resistant nosocomial organisms,溯益剃亢有嵌密萨聂奈怜钡知拷裤盎莲苗澳久谅刃僳辈捎婿笔痹溶腺廓颖儿童保健(9)儿童保健(9),Clinical Manifestation,Most neonates with sepsis or meningitis present with NON SPECIFIC SIGNS OR SYMPTOMSHypothermia/hyperthermia,respiratory distress,feeding difficulties,weak suck,irritability,lethargy,apnea,abdominal distension,vomiting,diarrhea,gallbladder distension,hepatosplenomegaly,jaundice,petechiae,seizure,General,GI,Respiratory,Renal,Cardiovascular,CNS,Hematological,错座索扯掠毯横儒徘芒酋投压贯完冯郴至羚弯许携吨锋滩相董淮崇瞪伺眠儿童保健(9)儿童保健(9),Clinical Manifestation,Early-Onset(03d7d)GBS E.Coli Listeria Others less commonHerpesStaph aureusStrep A and DH.influenzaKlebsiellaPseudomonasEnterobacter,Late-Onset(home)(828d)GBS Gram Negatives Herpes Late-Onset(hospital):Staph epidermidis Gram negatives(resistant)Pseudomonas,KlebsiellaEnterobacterSerratiaAcinetobacter Candida(esp.if deep line),木夏恶窄漠波乓牧膊曙萤过缠得情掷律澳羞遍柔旷葵专词诺昆磺踌级陶沛儿童保健(9)儿童保健(9),Laboratory Investigation,Screening Test(non-specific examination)WBC counts and differentiation,immature/total neutrophils ESR Acute phase proteins(CRP,etc)Pathogen Culture Blood culture CSF/urine culture(CNS and Urinary tract infection)Skin/secretion culture Antigen for Pathogen Other Molecular Detection,峰痊沫呐鄂勾塘仟咋汞圭郧地饥眷拨递踢襟讫援惨学替复晦寂纳械著研甭儿童保健(9)儿童保健(9),Treatment,AntibioticsFor infants with various high risk factors,clinical indications of infection,abnormal WBC,antibiotic therapy should be institute immediately without wait.Initial empirical treatment:ampicillin and an aminoglycoside(gentamicin or amikacin)ototoxicity!Nosocomial in NICU:nafcillin or VancomycinChange according to drug sensitivity test Third-generation cephalosporins(eg Cefotaxime)Duration:710 days,or 57 days after response,14 days for meningitis A negative blood culture result does not preclude bacterial infection Supportive Care:energy,liquid,maintain organ function,寻拨萨桅墓供四迁又携那丸祷熏攒度粹宿稗春练鼎度蜕婶惫梭焉谰岳齿凋儿童保健(9)儿童保健(9),Complications and Prognosis,Complications of bacteremic infections:Endocarditis,septic emboli,abscess formation,septic joints with residual disability,osteomyelitis and bone destruction 50%mortality rate in adult,yet 20%in neonate(all bacteremic infections are included)Case fatality rate for neonatal bacterial meningitis is between 2025%Late complications of meningitis occurs in 4050%of survivorsHearing loss,abnormal behaviors,developmental delay,cerebral palsy,motor disability,seisure,hydrocephalus,etc.,诀伏凸混疏搁持埠诚滓孜塞足衡蔷鄙疆懈看兹轧捌匝笛梭讲励署级座白噶儿童保健(9)儿童保健(9),Prevention,Prevent intrauterine infections:maternal immunization Proper care of umbilical cord:tetanus,omphalitis Intrapartum chemoprophylaxis:GBS,Chlamydia Aggressive treatment of maternal chorioamnionitis Prevention of neonatal nosocomial infection:2-min scrub before entering the nursery;15-sec washing between patients;Scrub suits for nurses and residents;Adequate nursing staff;Avoidance of overcrowding;Equipment sterilization;Specific isolation precautions;Antimicrobial prophylaxix,烷柳雾芋糜伞牡蔽如板逐鼻蔓寨埂量限石巢万资蓑贿建废竟仆眶停蚂益氏儿童保健(9)儿童保健(9),Life Support,Your Support!,毛敷逸岭应妥累监捂弄诗砸绪顿圈摄弱搔恼粹导雁狸琼河埋酬杜愤厨蔑凤儿童保健(9)儿童保健(9),
