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15 Cards in this Set
- Front
- Back
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Neonates are considered immunocomprimised
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True
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neonatal infection can be acquired
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before, during, or after birth
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Risk factors for neonatal infections
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-maternal intrapartum (during act of birth) infections
-gestational age <37 weeks and low birth weight (<2500 grams) -prolong rupture of membranes -traumatic delivery |
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Definition of newborn septicemia
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newborns who are <1 month of age, have positive blood cultures, and are ill appearing.
more low birth weight=more risk of infection |
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most common newborn pathogens for newborn septicemia
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-group B streptococcal (streptococcal agalactiae, GBS)
-E. Coli -L. monocytogenes |
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antenatal chemoprophylaxis:
recommeded when: for: Regimen: |
-antepartum screening at 35-37 weeks of gestation
--> recommended for women with -PMH of previous infant with invasive disease -positive GBS at antepartum screening -unknown GBS status -Ampicillin 2gm iv followed by 1gm q 4h until delivery |
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Pharmacological therapy of neonatal septicemia
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-Ampicillin (bactericidal, ae=diarrhea,less common= thrombocytopenia and neutropenia)
-AG (gentamicin, tobramycin, amikacin)-covers E.coli and other enteric gram-negative organisms, and P. aeruginosa |
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PK of AG
-serum peak conc. of gentamicin= |
-4-12mcg/ml (efficacy=higher peak=more kill)
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PK of AG
-serum trough conc. |
-.5-2 mcg/ml (toxicity)
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AE of AG
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oto and nephro
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when is it necessary to get peak/trough levels?
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-if treat for >72h
-birthweight <15g -if renal problem or unstable |
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never use in neonates because displaces bilirubin from protein
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ceftriaxone (only for meningitis)
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3rd generation not often used becuase of
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-resistance
-CNS penetration |
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3rd generation cephs (cefotaxime/ceftazidime- bacteriacidal) coverage
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gram neg. organism (no activity against enterococci or L. monocytogenes)
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empiric regimen (if no prophylaxis)
-->duration of tx |
ampicillin-AG/3rd generation cephalosporin (no meningitis, don't use)
-once sensitivities return, just GBS= can switch ampicillin to penicillin G -->neg. cultures with clinical improvement=48-72h -->neg. cultures w/o clinical improvement=7d -->positive cultures=variable (10-14d) |
