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15 Cards in this Set

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Neonates are considered immunocomprimised
True
neonatal infection can be acquired
before, during, or after birth
Risk factors for neonatal infections
-maternal intrapartum (during act of birth) infections
-gestational age <37 weeks and low birth weight (<2500 grams)
-prolong rupture of membranes
-traumatic delivery
Definition of newborn septicemia
newborns who are <1 month of age, have positive blood cultures, and are ill appearing.
more low birth weight=more risk of infection
most common newborn pathogens for newborn septicemia
-group B streptococcal (streptococcal agalactiae, GBS)
-E. Coli
-L. monocytogenes
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
Pharmacological therapy of neonatal septicemia
-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
PK of AG
-serum peak conc. of gentamicin=
-4-12mcg/ml (efficacy=higher peak=more kill)
PK of AG
-serum trough conc.
-.5-2 mcg/ml (toxicity)
AE of AG
oto and nephro
when is it necessary to get peak/trough levels?
-if treat for >72h
-birthweight <15g
-if renal problem or unstable
never use in neonates because displaces bilirubin from protein
ceftriaxone (only for meningitis)
3rd generation not often used becuase of
-resistance
-CNS penetration
3rd generation cephs (cefotaxime/ceftazidime- bacteriacidal) coverage
gram neg. organism (no activity against enterococci or L. monocytogenes)
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)