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Problems of the neonate and young infant Infection PowerPoint Presentation

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This medical is about the problems infection in neonate and young infant.

Infections are a significant concern for neonates and young infants, as their immune systems are not fully developed and they are more susceptible to infections than older children and adults. Some common infections that can affect neonates and young infants include Sepsis, Meningitis, Pneumonia, Urinary tract infections, and Gastrointestinal infections.

Its essential to seek prompt medical attention if a neonate or young infant shows any signs of infection, such as fever, irritability, poor feeding, or lethargy. Early diagnosis and treatment can help prevent serious complications and improve the infants overall health and well-being.

Tags : infection in neonate and young infant, Sepsis, Meningitis, Pneumonia, Urinary tract infections, Gastrointestinal infections, Neonatal-Perinatal Medicine, Neonatal-Perinatal Medicine

Published on : Jun 01, 2023 | Views : 1137 | Downloads : 0

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Slide 1-

Chapter 3Problems of the neonate and young infantInfection
Slide 2-

Case study: Dominic Dominic is a one week old boy. He was brought to the hospital with two day history of fever and lethargy. He was not able to breastfeed at all today.
Slide 3-

What are the stages in the management of any sick child?
Slide 4-

Stages in the management of a sick child (Ref. Chart 1, p. xxii) Triage Emergency treatment History and examination Laboratory investigations, if required Main diagnosis and other diagnoses Treatment Supportive care Monitoring Discharge planning Follow-up
Slide 5-

What emergency and priority signs do you see? Temperature: 35º C, pulse: 170/min, RR: 20/min
Slide 6-

Triage Emergency signs (Ref. p. 2,6) Obstructed breathing Severe respiratory distress Central cyanosis Signs of shock Coma Convulsions Severe dehydration Priority signs (Ref. p. 3) Tiny baby Temperature Trauma Pallor Poisoning Pain (severe) Respiratory distress Restless, irritable, lethargic Referral Malnutrition Oedema of both feet Burns
Slide 7-

What emergency treatment does Dominic need?
Slide 8-

Emergency treatment Airway management? OK Oxygen Not “respiratory distress”, but…slow breathing, periods of apnoea Intravenous fluids Unable to feed, prevention of hypoglycaemia Correct hypothermia (Ref. p. 202, p. 259) Immediate investigations? □ Blood sugar
Slide 9-

Dominic was delivered at term at home by a village birth attendant. He cried immediately. His cord was tied with a shoelace and then cut with a knife. He passed meconium within 24 hours of delivery. He was breast-feeding well until two days ago, after which he developed fever and lethargy (drowsiness). This morning he stopped sucking on the breast. His mother Sarah did not attend any antenatal clinics during her pregnancy and she did not receive tetanus toxoid. Sarah’s pregnancy was uneventful. There is no history of premature rupture of membrane. History
Slide 10-

Dominic was lethargic and had grunting respiration. Vital signs: temperature: 34.5ºC, pulse: 170/min, RR: 20/min Weight: 2.7 kg Chest: Sometimes periods of not breathing for 10 seconds, bilateral air entry good Cardiovascular: both heart sounds were audible and there was no murmur Abdominal examination: soft, bowel sound was present; liver was 2 cm below the right costal margin Ears-Nose-Throat: mouth: slightly dry, no oral thrush; ears: clear, no discharge Neurology: lethargic; no neck stiffness; fontanelle normal Skin: no rash Examination
Slide 11-

Birth asphyxia Birth trauma Intracranial haemorrhage Neonatal tetanus Sepsis (pneumonia, cord infection, skin infection, UTI) Differential diagnoses(Ref. Neonate with lethargy p. 25)
Slide 12-

Further examination based on likely sepsis Look for signs of serious bacterial infection and for localizing signs of infection: (Ref. p. 54-55) Deep jaundice Severe abdominal distension Painful joints, joint swelling, reduced movement Skin pustules Umbilical redness, flare or pus Bulging fontanelle Assess hydration and nutrition (ill not feeding)
Slide 13-

What investigations would you like to do to make your diagnosis ?
Slide 14-

Investigations Blood glucose Haemoglobin Urine microscopy or culture Lumbar puncture Blood culture if possible
Slide 15-

Haemoglobin: 85g/l (125 – 205) Platelets: 86 x 109/l (150 – 400) WCC: 2.9 x 109/l (5.0 – 19.5) Neutrophils: 0.5 x 109/l (1.0 – 9.0) Lymphocytes: 2.1 x 109/l (2.5 – 9.0) Monocytes: 0.3 x 109/l (0.2 – 1.2) Blood sugar: 3.3 mmol/l (3.0 – 8.0) Full blood examination
Slide 16-

Urine dip-stick testing: - Protein / Glucose: nil - Nitrate / Leucocyte esterase: nil - Blood: nil Microscopy: - Red Blood Cells: 0 x 106/l (<13) - Leucocytes: 0 x 106/l Culture: - No growth Urine
Slide 17-

Diagnosis Summary of findings: Examination: hypothermia, lethargic, slow breathing, some apnoea, soft grunting respirations Blood examination shows neutropenia and thrombocytopenia Localizing signs of infections – unsterile cord care Blood culture pending  Sepsis
Slide 18-

How would you treat Dominic?
Slide 19-

Treatment □ IM / IV antibiotics for 10 days (Ref. p. 55):  Ampicillin (or penicillin) and gentamicin (Ref. p. 69-72) If Staphylococcal aureus suspected (skin pustules, umbilical infection, boils, septic arthritis) administer cloxacillin (or flucloxacillin) instead of ampicillin/penicillin □ If not improving in 2-3 days the antibiotic treatment may need to be changed
Slide 20-

What supportive care and monitoring are required?
Slide 21-

Supportive Care Fluid management and feeding (Ref. p. 57) Maintain a stable temperature in normal range (Ref. p. 56) Strict attention to hand washing
Slide 22-

Monitoring Monitor response to treatments and look for complications: Oxygen saturation Apnoea monitoring if possible Vital signs Treatments given Feeding/nutrition given Blood glucose Use a Monitoring chart (Ref. p. 320, inside back cover)
Slide 23-

Summary Signs of neonatal sepsis are non-specific: temperature instability, poor feeding, apnoea, bradycardia, jaundice, lethargy Good history and examination are very important Antibiotics, oxygen, prevention of hypothermia and hypoglycaemia, breast milk are good general treatments for very unwell neonates Frequent monitoring and reassessment Nurse with mother if not too sick