neonatal infections/infections in newborn.pptx

nursing management of common childhood disorder

1. NEONATAL INFECTIONS PRESENTED BY: M.C.KNIRANDA ASSISTANT PROFESSOR SSNSR, SU.

2. DEFINITION OF NEONATAL INFECTIONS : Invasion and uncontrollable growth of pathogenic microorganisms in the body of neonate is known as neonatal infections. MODE OF INFECTION : Antenatal Intranatal Postnatal

3. MODE OF INFECTION : ANTENATAL : Transplacental : Maternal infections may occur due to various microorganisms and described with an acronym of STORCH where in: S: syphilis T: toxoplasmosis O: Other (Gonococci Infections, Tubercular Infections, Malaria, Varicella, Hepatitis B, HIV etc.) R: Rubella C: Cytomegalovirus H: Herpes Simplex Virus

4. MODE OF INFECTION : INTRANATAL : Aspiration of infected liquor or meconium following early rupture of membranes which may lead to neonatal aspiration pneumonia . Infected birth passage may infect the eyes and mouth of neonate leading to Ophthalmia neonatorum and oral thrush . Improper aseptic technique during care of umbilical cord may cause umbilical sepsis .

5. MODE OF INFECTION : POSTNATAL : Transmission of infection from human contact or caregivers especially from infected hands of mother or family members and health care providers Cross infection from other baby who is infected and no barrier nursing is practiced and universal precautions are not followed Infected articles for baby care and contaminated clothing Infected environment around the neonates at hospital or home

6. OPHTHALMIA NEONATORUM (CONJUNCTIVITIS)

7. DEFINITION : Ophthalmia neonatorum is a bacterial eye infection in newborn infants that is passed from a mother with a gonorrhea or chlamydia infection during birth , in the first 10 days of life. Causes : Unilateral conjunctivitis after five days of life is often due to Chlamydia trachomatis Other bacterial causes: Gonococcus, staphylococcus, pseudomonas Viral: herpes simplex Chemical: Silver nitrate

8. Mode of infection : It includes infected hands of the caregivers , infected birth canal and cross infection from other infected infants. During neonatal period, there may be direct contamination from other sites of infection like skin and umbilicus. Clinical Features : The neonate may present with sticky eyes with or without discharge . The eyelids may be markedly swollen and stuck together with redness of the eyes. Cornea may be involved in severe cases.

9. DIAGNOSTIC STUDIES: Culture of the drainage from the eye to look for bacteria or viruses. Slit-lamp examination to look for damage to the surface of eyeball . TREATMENT : Gonococcal Conjunctivitis : Topical administration of broad spectrum antibiotics (gentamicin eye drops every hour) + A single dose of ceftriaxone(75-100m/kg/day IV or IM QID FOR 7 days)

10. TREATMENT : Chlamydial Conjunctivitis : Topical erythromycin eyedrops (5x/day) + Oral erythromycin(50 mg/kg/d divided QID) Herpetic Conjunctivitis : - Acyclovir eye ointment - Systemic acyclovir 30 mg/kg/day IV TID, for 14 days up 21 days (in severe cases) PREVENTION : Infection can be prevented by cleaning the eyes immediately after birth and applying either 1% silver nitrate solution, 1% tetracycline or 0.5% erythromycin ointment to the eyes with in one hour of the delivery.

11. NURSING MANAGEMENT Cleaning Clean the affected eye(s) with sterile water or 0.9% saline, wiping from nose to outer aspect of eye. Repeat 4 to 6 times a day for 2 to 3 days.  Massage Massage the nasolacrimal ducts daily by pressing downwards on the side of the nose from the corner of the eye to the nostril.  Antibiotic ointment Apply an antibiotic eye ointment, such as tetracycline or erythromycin, within one hour after delivery.

12. NURSING MANAGEMENT Monitor Monitor for signs of infections in other parts. Consultation Consult a pediatrician or pediatric infectious specialist. Treatment Continue treatment according to clinical presentations and culture results. Treatment may be modified later per culture results

13. OMPHALITIS (Umbilical Sepsis)

14. DEFINITION : Omphalitis is the medical term used for inflammation of the umbilical cord stump in the neonatal newborn period, commonly attributed to a bacterial infection. CAUSES : The causes usually are Staphylococcus aureus, Streptococcus and Escherichia coli . The infection is typically caused by a combination of these organisms.

15. CLINICAL FEATURES : Patient present with redness and swelling (Cellulitis) around the umbilicus Purulent or mal odorous discharge from the umbilicus Baby is highly irritable Delay in the falling off the cord The cellulitis is rapidly progressive

16. DIAGNOSTIC STUDIES : Obtain specimen from umbilical infection Blood culture CBC Treatment : Antimicrobial Therapy : A combination of parenterally administered anti- staphylococcal penicillin and an Aminoglycoside is usually recommended CLOXACILLIN + GENTAMYCIN

17. NURSING MANAGEMENT Cleaning Clean the umbilical cord stump with 95% alcohol to promote drying. After the stump falls off, use 75% alcohol as a disinfectant. Clean in a clockwise direction, starting at the stump and working outward for at least 5 centimeters.  Keeping it dry Keep the umbilical cord area clean and dry. Fold the diaper down below the umbilical area to prevent urine from getting on it.  Antibiotics Most babies will need a short hospital stay to receive intravenous (IV) antibiotics. The type and duration of antibiotics will depend on the baby's clinical response and any complications

18. Other treatments In some cases, a surgical procedure may be needed to clean out infected tissue. Other treatments may include antiviral medication, heart and/or blood pressure medications, and extra oxygen.  Educating parents Educate the parents or guardians about the procedure and how to care for the umbilical cord NURSING MANAGEMENT

19. TETANUS NEONATORUM

20. DEFINITION : Neonatal tetanus is the generalized tetanus infection of the newborn. It usually gets transmitted from an unvaccinated mother and enters the body through the infection of unhealed umbilical stump. This typically happens when the umbilical cord is cut using unsterile instruments . CAUSATIVE ORGANISM: Clostridium tetani CLINICAL FEATURES : The features are evident within 5-15 days after birth. Initial symptom is inability to suck and inability to open mouth known as trismus, irritability and excessive cry.

21. With in12-24 hours after the first, generalized tonic convulsions occur producing flexion and adduction of the arms, clenching of fists and extension of the lower extremities. Initially spasms are mild but later become severe with spasms of glottis and respiratory muscles. Opisthotonos (the muscle spasms will cause child’s back to be severely arched and child’s heels and head will be bent back to an extreme degree)

22. TREATMENT : Isolate the baby in dark and silent room Washing and debridement of the infected site and administration of antibiotics such as Benzyl penicillin or Metronidazole . Anti-toxin, Anti-tetanus serum (50,000- 1,00,000 U) Human tetanus immunoglobin (3,000-6,000 U) Sedation: Diazepam 0.1-0.2 mg/kg Phenobarbitone 15mg/kg per day in divided doses Feeding by: NG Tube Daily milk requirement- 100-120ml/kg/day

23. NECROTISING ENTROCOLITIS

24. DEFINITION : Necrotizing enterocolitis is an intestinal (bowel) disease that primarily affects the premature infants. “Necrotizing” refers to cell damage and death, “entero” to the intestine and “colitis” to inflammation that occurs in the lower intestine (colon). RISK FACTORS : Premature infants Hypotension Polycythaemia ( ncreased red blood cell mass) Septicaemia due to E.coli., Klebsiella, Pseudomonas Umbilical cord catheter related thromboembolism ( blood clot that gets stuck and causes an obstruction) Exchange Transfusion

25. CLINICAL FEATURES : Systemic signs: Respiratory distress Lethargy Feeding intolerance Hypertension Acidosis Oliguria Bleeding diathesis Abdominal signs Abdominal distension Tenderness Bloody stools Vomiting bile(which appears green)

26. DIAGNOSTIC STUDIES : 1 . Abdominal X-ray 2 . Ultrasonography 3 . Stool analysis

27. TREATMENT : Stopping all regular feedings . The baby receives nutrients through intravenous (IV) catheter. Placement of a nasogastric tube . The tube suction air and fluids from the baby’s stomach and intestine, relieving swelling and discomfort. Starting antibiotic therapy . If abdominal swelling interferes with breathing, providing oxygen or mechanically assisting breathing. Taking frequent blood test to detect signs of infection and imbalances in the body’s chemistry. In severe cases, platelet and red blood transfusion may be necessary.

28. NURSING MANAGEMENT Stopping feedings : The first step is to stop all oral or tube feedings to allow the intestines to rest and heal. Intravenous fluids : IV fluids and nutrients are given to replace fluids and provide nutrition. Nasogastric (NG) tube : A long, thin tube is inserted through the nose or mouth and into the stomach to remove gas and fluids. Antibiotics : Broad-spectrum antibiotics are given to fight bacterial infections and allow the bowel to heal. Isolation : Protective gowns and gloves are used to prevent the spread of infection

29. ORAL THRUSH

30. DEFINITION : Oral thrush is an infection of yeast fungus , Candida albicans that appears as whitish, velvety lesions in the mouth and on the tongue. It is common in infants. CAUSES : Oral thrush may occur in babies because their immune systems have not yet matured . They are less able to resist infection. An oral thrush can happen after treatment with antibiotics , because antibiotics reduce the levels of healthy bacteria in the mouth. This allows fungus to proliferate. If a mother had to deal with vaginal yeast infection , then a baby could have picked up Candida in the birth canal. If a mother breastfeed and her nipples are red and sore , she might have a yeast infection on her nipples, which a mother and a baby can pass back and forth.

31. CLINICAL FEATURES : Usually appear in the late 1 st week or during the second week Soft whitish adherent patches on oral mucous Painless Removed with little difficulty TREATMENT : Topical: Nystatin (100,000 U/ml), 1 ml is applied to each side of the mouth QDS for 7-10 days Systemic : Fluconazole (50mg/day) for 7-10 days PREVENTION : Maternal fungal infection is to be adequately treated before delivery. Utensils including feeding bottles and teats are to be properly cleansed before & after each feed.

32. NURSING MANAGEMENT Nursing management of neonatal oral thrush involves  treating the baby and the nursing parent, and practicing good hygiene to prevent reinfection Treat the baby A healthcare professional may prescribe an antifungal medication to paint on the baby's mouth and tongue. Thrush often goes away on its own in a few days.  Treat the nursing parent If the nursing parent has a yeast infection on their nipples, a healthcare professional may recommend an antifungal cream to apply to the nipples. The cream should be wiped off before nursing. 

33. Practice good hygiene Sterilize the baby's pacifiers, bottle nipples, and breast pump parts.  Wash the baby's hands, toys, and pacifiers frequently.  Wash clothing, towels, and bras that have come into contact with the nipples in a hot wash cycle.  Keep the nipples clean and dry between feedings.  Boil pacifiers and toys for 20 minutes each day.  Replace pacifiers and bottle nipples after one week.  Wash hands frequently, especially after diaper changes.  Avoid diaper wipes if the baby has a diaper rash.  NURSING MANAGEMENT

34. SKIN INFECTIONS

35. DEFINITION : A skin infection is a condition where bacteria or other germs enter the skin through a wound and spread , causing pain, swelling and discoloration. Newborn’s skin infections may manifest as skin rashes, pustulosis or cellulitis. PUSTULOSIS Pustulosis is  a skin condition that causes large, fluid-filled blisters , called pustules, to appear on the palms of the hands and/or soles of the feet Presents in the first 3 weeks of life Caused by Malassezia (fungal infection) Site – cheeks, chin, eyelids, neck and upper chest

36. TREATMENT: Self-limiting nature, heals in 1-3 months without scarring Persist/widespread- 2% ketoconazole cream for 15 days 2. CELLULITIS Deep bacterial infection of the skin Infection usually involves the face, arms and legs Caused by the bacterial infection of a wound area of skin that is no longer intact. The most common causative organisms are: Group A beta– Hemolytic streptococcus, Streptococcus pneumoniae and Staphylococcus aureus In severe infections or in a premature infant, complete blood count (CBC) and blood culture are to be obtained. TREATMENT : Systemic antibiotic (Oxacillin or Nafcillin and Gentamicin) IV is given.

37. PREVENTATIVE INTERVENTIONS FOR INFECTIONS IN NEWBORN : Improved nutrition during pregnancy. Identification and treatment of infections in mother Five clean practices should be followed during delivery: clean hands, clean cord tie, clean cord, clean surface, and clean blade . Sixth clean practice include clean clothing for mother & baby. Handwashing before and after handling of the babies. Maintenance of cleanliness of the environment i.e. delivery room, neonatal care unit and postnatal area. Improved newborn care practices(breastfeeding, cord care, thermal care) Extra care and attention to preterm/LBW

38. NURSING MANAGEMENT Diapers : Change diapers often, especially after the baby urinates or has a bowel movement. Wash your hands before and after changing diapers.  Bathing :  Bathe baby two to three times a week with lukewarm water and mild, fragrance-free baby soap and shampoo. Only apply soap to dirty areas. For babies under 32 weeks gestation, consider using warm water only during the first week.  Skin dryness : If the baby's skin is dry, flaking, or cracked after a bath, apply an emollient.  Nails : Trim baby's nails when they get sharp to prevent scratches.  Clothing : Wash baby blankets, sheets, and clothing before and after use using fragrance-free detergents. 

39. NURSING DIAGNOSES : Infection related to presence of microorganisms in the body Hyperthermia or hypothermia related to infectious process Impaired skin integrity related to presence of lesions Delayed growth and development related to inadequate feeding and presence of infection Impaired parenting related to separation secondary to admission in the NICU.

40. THANK YOU