Sepsis

exp date isn't null, but text field is

IntroductionA clinical syndrome resulting from bacterial blood stream infection with active proliferation of the organisms.
Early-Onset sepsis manifests within the first 72 hours of life or at most 7 days of life while Late-Onset sepsis manifests after 7 days of life.
Terminologies

• Early-Onset sepsis is presumed when risk factors for sepsis are present but
  the infant has no clinical feature suggestive of sepsis.
• In probable sepsis, an infant has clinical and/or laboratory features
  suggestive of sepsis without bacteriological confirmation.
• Sepsis is latent when Clinical Features are present with laboratory features
  such as deranged full blood count or elevated serum C-Reactive Proteins
  and serum Interleukins but without positive blood culture.
• Sepsis is confirmed when blood culture is positive in addition to clinical
  manifestations.

Clinical Features

• Non-specific features include fever, vomiting, poor feeding, poor activity
• More specific features include hypothermia, poor skin color, jaundice, abdominal distension, respiratory distress, apnea and bleeding tendencies.
• There may be local manifestations of serious illnesses such as omphalitis, otitis media, pneumonia, diarrhoea or urinary tract infestation.

Investigations

• FBC and ESR
• Elevated C-Reactive Protein
• Elevated procalcitonin
• Elevated interleukins 1,6,8 and positive blood culture
• Others will include specific ancillary tests for localized diseases such as
  chest X-Ray, mid-stream urine and other swabs for bacteriological studies.

Treatment

• For presumed sepsis in the developing world, it is recommended that blood
  culture should be requested and the infant is immediately commenced on
  empirical antibiotic therapy based on the local pattern of organisms and
  their sensitivity pattern. Intravenous cefuroxime 50 mg/kg 12-hourly and
  gentamicin 2.5 mg/kg 12-hourly. The infant should be closely monitored
  for any evidence of clinical deterioration. If the infant remains
  asymptomatic and the blood culture yields no growth, the antibiotics can be
  safely discontinued after 48 hours.
• For probable sepsis, blood culture should be requested while the infant is
  commenced on antibiotics: intravenous second or third generation
  cephalosporins; Cefuroxime 50mg/kg 12-hourly or Ceftriaxone 75mg/kg
  daily or Cefotaxime 50mg/kg 8-hourly and gentamicin 2.5mg/kg 12-hourly
  for 10 to 14 days depending on the clinical response. It may be necessary to
  change the antibiotics if the sensitivity report from the laboratory suggests
  resistance to the drugs in use.
• Support care: Fluid and caloric balance, dextrose for hypoglycaemia, blood
  transfusion for severe anaemia, oxygen therapy and ventilators supports for
  hypoxaemia.