The treatment of neonatal sepsis

　Neonatal sepsis neonatal period refers to the bacteria invade the blood circulation and in which growth and reproduction and production of toxins caused by systemic infection. The following are the diagnostic criteria of neonatal sepsis and treatment.
A diagnosis

(A) risk factors

1, the mother's medical history: the mother during pregnancy and the production history of infection (such as urinary tract infections, human chorionic amniotic etc), the mother's birth canal colonization of specific bacteria, such as group B hemolytic streptococcus (GBS), Neisseria gonorrhoeae and so on.

2, obstetric factors: premature rupture of membranes, birth process to extend the amniotic fluid turbid, or smelly, dirty environment, or the delivery, when birth lax sterilization, prenatal, intrapartum invasive inspection.

3, fetal or neonatal factors: multiple birth, fetal distress, premature children, small for gestational age children, long-term arterio-venous catheters, endotracheal intubation, surgery, bad behavior on the newborn, such as pick "horse teeth", squeezing breast, squeezing carbuncle furuncle etc., neonatal skin infections such as impetigo, diaper dermatitis and the umbilical, lung infections are also common causes.

(B) pathogen

Staphylococcus aureus and Escherichia coli in China with mainly coagulase-negative staphylococci (CNS) mainly observed in the preterm children, particularly for chronic arterio-venous catheter persons; of Staphylococcus aureus were mainly seen in pyogenic skin infections; prenatal or perinatal Infection with Escherichia coli-based Gram-negative (G-) bacteria are more common. Intubation and mechanical ventilation in children with G-bacteria such as Pseudomonas aeruginosa, Klebsiella pneumoniae, Serratia bacteria more common.

(C) Clinical manifestations

1, general Performance

(1) temperature changes: may have fever or low body temperature.

(2) eat less, less crying, less animals looking poor, cold extremities, weight does not increase or slow growth.

(3) jaundice: sepsis is sometimes the only performance, severe bilirubin encephalopathy can develop.

(4) shock performance: cold extremities, with piebald, the femoral artery pulse weakened, capillary filling time prolonged, blood pressure, severe cases may have disseminated intravascular coagulation (DIC).

2, the system performance

(1), skin, mucous membranes: Scleroderma, subcutaneous gangrene, impetigo, Cullen, or other parts of the cellulitis, nail bed infections, skin burn burns, purpura, petechia, oral mucous membrane injury picked cut.

(2) Digestive: anorexia, abdominal distension, vomiting, diarrhea, severe, there may be toxic paralytic ileus or necrotising enterocolitis (NEC), later there may be hepatosplenomegaly.

(3) Respiratory: shortness of breath, cyanosis, irregular breathing or apnea.

(4) central nervous system: easy to merge purulent meningitis. Manifested as lethargy, irritability, convulsions, anterior fontanel tension and limbs, increased muscle tone and so on.

(5) Cardiovascular System: infective endocarditis, septic shock.

(6) the blood system: can be combined thrombocytopenia, bleeding tendency.

(7), urinary tract infections. Others: suppurative inflammation of bone joints, such as osteomyelitis and deep abscesses.

(D) laboratory tests

1, bacteriological examination

(1) Bacterial culture: as far as possible in the application of antibiotics before the blood collection done under strict sterile blood culture, believed to be infected with intestinal anaerobic culture should also be made, there is a long time with penicillins and cephalosporins should do L-type bacterial culture. Suspected prenatal infection, gastric juice obtained within 1h after birth and the external ear canal secretions culture, or Gram stain smears look for multinucleated cells and intracellular bacteria. When necessary, desirable to clean urine culture. Cerebrospinal fluid, umbilical infection, serous cavity fluid, and all removal of the catheter should be sent to the first train.

(2) The pathogenic antigen and DNA detection: antibody test fluids with known and unknown antigen, GBS and E. coli K1 antigen on the CIE can be used, latex agglutination test and enzyme-linked immunosorbent assay (ELISA) and other methods that have been the use of antibiotics are more diagnostic value; 16SrRNA gene using polymerase chain reaction (PCR) genotyping, DNA probes and other molecular biology techniques to assist in early diagnosis.

2, non-specific inspection

(1) white blood cell (WBC) count: birth 12h after blood results more reliable. WBC reduction (<5 × 109 / L), or the WBC increased (≤ 3d were WBC> 25 × 109 / L;> 3d were WBC> 20 × 109 / L).

(2) WBC Category: rod nucleated cells / neutrophils (immature / totalneutrophils, I / T) ≥ 0. 16.

(3) C-reactive protein (CRP): the acute phase proteins to carry out the more common and more sensitive projects, inflammation occurs immediately after 6 ~ 8h higher, ≥ 8μg/ml (peripheral blood method). The unit can be used for conditions of serum procalcitonin (PCT), or interleukin-6 (IL 6) determination.

(4) platelets ≤ 100 × 109 / L.

(5) The micro-ESR ≥ 15mm/1h.

(E) diagnostic criteria for

1 to determine the diagnosis: a clinical and comply with any of the following one (1) blood culture or sterile body cavity cultivate pathogens; (2) If the blood cultures foster opportunistic pathogen, it must be with the other times (copies) of blood , or sterile body cavity or duct first train out of the same kinds of bacteria.

2, clinical diagnosis: a clinical and having any of the following one (1) non-specific inspection ≥ 2 Tiao. (2) blood samples positive for pathogenic bacteria antigens, or DNA testing.