Pediatricians tend to interpret PROM as prolonged rupture of the membranes, defined as 18 hours of more of membrane rupture prior to delivery of the baby. Obstetricians tend to define PROM as premature rupture of the membranes: greater than 4 hours of membrane rupture with no labor pattern established. BE AWARE: the abbreviation PROM is ambiguous. Prolonged rupture of membranes (PROM).placement of umbilical or urinary bladder catheters, intubation, etc. This may include clinical evidence of chorioamnionitis (tender, painful uterus, sustained tachycardia), fever prepartum or postpartum, abnormal WBC count (>20,000 or 160/minute) Maternal infection at the time of delivery (chorioamnionitis, urinary tract).pallor or mottling, slow capillary refill, hypotensionįactors which place a neonate at increased risk for EOS include:.poor temperature control, particularly hypothermia.Frequently, the nurse is the first to become suspicious and say "the baby is just not acting right." Clues include The signs of neonatal sepsis are extremely subtle in the newborn. Some experts consider infections acquired after 48-72 hours in the hospital to be hospital-acquired. Late onset neonatal sepsis (LOS) (from 8-90 days of life) affects two populations: healthy term infants in the community (which we will not discuss further) and preterm babies in the NICU - often referred to as nosocomial or hospital-acquired sepsis. However, the incidence of non-GBS early onset sepsis is increasing for VLBW infants. Intrapartum prophylaxis for GBS has resulted in decreasing rates of early onset sepsis (EOS) for term infants. The definitions vary depending on the source of the literature, but the conclusions are generally comparable. Neonatal infections have been classified as early-onset ( 3-7 days of age) and very late onset ( > 90 days of age). These defects include immature cutaneous and mucosal barriers, low concentrations of T and B cells and lack of antigenic memory. The high susceptibility of the developing fetus and newborn to sepsis is due to functional defects of both innate and adaptive immunity. The incidence of proven sepsis is 20% in VLBW babies and up to 50% in the ELBW infant (less than 1000 g.). Proven sepsis in term infants is not common (1- or 0.1%), but the diagnosis of suspected or clinical sepsis is made frequently. Sepsis is defined as isolation of bacteria or other pathogenic organism from the blood of a baby with clinical signs. Our findings indicate that 1) patients with GNB CSF shunt infections often appear relatively well at presentation 2) CSF positive for GNB by Gram's stain and very low CSF glucose levels predict continued positive CSF cultures, despite appropriate antibiotic therapy and 3) GNB CSF shunt infections can be successfully treated by prompt shunt removal, extraventricular drainage, and intravenous antibiotics.NEONATAL SEPSIS and OTHER INFECTIONS Definitions One patient died of unrelated causes shortly after treatment.
Only 2 of 19 patients (11%) who were followed up suffered apparent CNS damage. The overall cure rate was 100%, and no recurrence was observed however, a subsequent infection with a different organism developed in four patients. At admission, these patients had CSF glucose levels of < 10 mg/dl and CSF positive for GNB by Gram's stain. Extraventricular drainage revision and/or intraventricular antibiotics were required in four patients whose CSF cultures were persistently positive for GNB. Initial treatment always included immediate shunt removal, externalized ventricular drainage, and intravenous antibiotics.
Escherichia coli was isolated from 12 of 23 patients (52%), Klebsiella pneumoniae from 5 (22%), and mixed GNB from 3 (13%) patients. The most frequent symptoms were fever, lethargy, and irritability the illness was not severe in the majority of these patients. Of these infections 20 (87%) occurred within 4 weeks after shunt revision (median, 10 days). The authors reviewed all GNB shunt infections treated at Children's Memorial Hospital from January 1986 to January 1990 (n = 23). The prognosis of CSF shunt infections caused by Gram-negative bacteria (GNB) has been thought to be particularly poor. Infection causes major morbidity and mortality in patients with cerebrospinal fluid (CSF) shunts.
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