Neonatal sepsis coaching for nursing students.pptx

Neonatal sepsis for nurses

1. Emergency Obstetric and Newborn Care Neonatal sepsis

2. Learning objectives At the end of this session, the participant should be able to: define neonatal sepsis Recognize infant who is at risk Assess the infant with severe neonatal sepsis classify a young infant for very severe disease and local bacterial infection Manage the infant Counsel the mother

3. Definition Neonatal sepsis can be defined as bacterial infection occurring in the first 28 days of life Infection can be generalized or localized

4. Magnitude of the problem Neonatal sepsis is very common Source: Adapted from the Child Health Epidemiologic Reference Group Lancet Publication May 12, 2010

5. Why neonates are prone to infection Decreased humeral immunity Decreased cellular immunity Decreased white cell activity Deficient complement system Reduced IgA Thin skin Risk factors PROM Maternal infection Antepartum haemorrhage Prematurity Respiratory distress syndrome.

6. Diagnosis The clinical signs of infection in the newborn are often non specific and difficult to recognize. The findings listed below can be caused by other problems besides infection.

7. How to recognize neonatal sepsis Not specific Newborn infant with sepsis may present with any of the following: Generalized clinical signs Convulsions Lethargic or unconscious Not feeding well Fast breathing (60 breaths per minute or more) Periods of not breathing Fever (37.5 C or above or feels hot) or low body temperature (less than 35.5 C or feels cold) Jaundice

8. How to recognize neonatal sepsis Localized signs Umbilical redness, smelly or oozing pus Severe skin pustules Fast breathing Eye infection ( swollen with profuse eye discharge)

9. Other signs of severe sepsis Difficulty waking up the baby Rapid or slow breathing; indrawing of chest with breathing Periods of apnoea lasting more than 20 seconds Pale, grey or blue colour (blue tongue or lips is serious) Limp or rigid limbs Jaundice Distended abdomen

10. Classify illness Classify (IMNCI classification): Very severe disease or Local bacterial infection Bacterial infections can progress rapidly in young infants. Classify (other classification) Severe neonatal sepsis

11. Management of neonatal sepsis Ensure patent Airway, Provide oxygen if indicated* Use bag and mask if not breathing well Give first dose of Crystalline penicillin 100,000 IU/kg stat and 12 hourly and Gentamycin 5mg/kg stat and once daily. If preterm < 2kg give Gentamycin 4mg/kg stat and once daily

12. Management of neonatal sepsis Give small frequent feeds if possible to prevent low blood sugar If too ill to feed use NG tube starting with 60mls/kg/day divided into 12 feeds. Arrange for URGENT referral to next level Stabilize and refer to next level Keep the Infant warm on the way to the Hospital

13. Management of neonatal sepsis Local bacterial infection: Umbilical infection Examine the cord and abdomen. Look for: Moist cord Drainage of pus with a bad smell Red, swollen, inflamed skin around the umbilicus Distended abdomen (a sign that the baby is developing very severe disease) Classify (IMNCI) Serious umbilical cord infection Localized umbilical cord infection

14. Management of neonatal sepsis Classify: Serious umbilical cord infection if: There is pus discharge from the umbilicus, delayed cord separation or healing plus redness of skin and swelling which extends more than 1 cm around the umbilicus. The skin around the umbilicus may also be hardened. If baby has signs of sepsis such as a distended abdomen, the infection is very serious. Treat: Serious umbilical cord infection in the same manner as very severe disease

15. Management of neonatal sepsis Classify: Localized umbilical cord infection (non serious) if; The umbilicus has no pus discharge or foul smell. Redness and swelling around the skin of the umbilicus does not extend more than 1 cm. The baby has no danger signs. Treat localized bacterial infection: Give an appropriate oral antibiotic. ( Amoxycillin ) Teach the mother to treat local infections at home (cord care). Advise mother to give home care for the young infant. Follow-up in 2 days Teach mother about danger signs Advise mother when to return immediately.

16. Eye infection Red or swollen eyes with profuse pus discharge: Refer the baby, following the Referral Guidelines. For a baby less than 7 days old who has not been treated with antibiotics, treat for eye infection due to gonorrhoea. Give a single dose of antibiotics before referral: ceftriaxone 50mg/kg IM (do not give more than 125 mg) Start frequent eye irrigation with saline Refer the mother for STI screening and treatment for her and partner.

17. Case study 1 Mai Mutsa gave birth to her third baby at Rusitu Hospital two days ago. Her pregnancy, labour, and birth were uncomplicated. She noticed yesterday that her baby’s cord looked reddish. She has brought the baby to the health centre because she is concerned that the cord may be infected. The health worker observes that the baby has normal colour, normal breathing, and that he is breastfeeding well. The health worker looks at the umbilical cord. The cord is moist and has some redness around it measuring less than 1 cm. There is no drainage or bleeding. The health worker feels the baby’s body and determines that the temperature is normal. Discussion Questions: 1. Based on these findings, what is the baby’s problem? 2. Based on the problem/need you identified, what is your plan of care for Mai Mutsa’s baby?

18. Case study 1 - answers 1. Based on these findings, what is the baby’s problem? The baby has a localized cord infection. He has a moist cord with an offensive odour. The baby does not have a serious cord infection because the skin around the umbilicus is not red or inflamed, there is no drainage, and the baby has no signs of sepsis.

19. Case study 1 - answers 2. Based on the problem, what is your plan of care for Mai Mutsa’s baby? Wash your hands with clean soap and water and dry them on a clean towel before handling the cord. Apply surgical spirit or methylated spirit generously with every nappy change. 3. Wash your hands again after applying the alcohol. 4. Teach the mother to do this treatment with every nappy change until healed. 5. Advise the mother to seek medical care immediately if: - the problem does not improve after 3 days - the baby has any danger signs - the area around the cord becomes hardened - redness and swelling increase or - the abdomen becomes distended.

20. Key points Neonatal sepsis is very common Any very ill newborn infant may have neonatal infection Keep the baby warm, feed and counsel the mother Give Xpen and gentamycin before referral of an infant with very severe disease Refer urgently if infant develops danger signs