Prevention of neonatal infection
•
Good
hand washing with antiseptic solutions and use of gloves.
•
Avoidance
of overcrowding.
•
Low
nurse to patient ratio.
•
Nurse
cohorting.
•
Patient
isolation and barrier nursing.
•
Minimal
handling.
•
Rational
antibiotic use.
•
Minimize
indwelling vascular access.
The best approach to minimize
early onset sepsis due to Group B strepto-coccal infection is uncertain because
there have not been trials that permit the overall risks and benefits of
intrapartum antibiotic prophylaxis (IAP) to be judged. IAP reduces the number
of newborns with positive blood cultures, but with a very low disease incidence
and a very high rate of ma-ternal GBS colonization (around 25%) a very large
number of women must be treated to prevent a case if bacteriological screening
programs are implemented. Routine bacteriological screening of pregnant women
is not presently recommended in the UK. Current practice follows a risk factor
based approach. The incidence of early-onset GBS disease in term infants
without antenatal risk factors in the UK is 0.2cases/1000 births.
The Royal College of Obstetrics
and Gynaecology1 recommend that intrapartum IV penicillin (or
clindamycin) should be offered to women with a previous baby with neonatal GBS
disease. Other risk factors that should prompt consideration of IAP are:
•
intrapartum
fever >38*C;
•
preterm
(<37/40);
•
PROM
>18hr;
•
GBS
maternal carriage detected on low vaginal swab culture or GBS bacteriuria.
Management of the newborn is not
well evidenced. Any ill newborn infants should have cultures taken and be
treated with broad spectrum antibiot-ics that are effective against Group B
streptococcus and other common neonatal pathogens.
Well infants exposed to the above
risk factors should be evaluated clini-cally and observed. Because more than
90% of cases of early onset GBS disease present in the first 12–24hr after
birth. Infants who remain well after this time are not at increased risk of
disease in comparison with infants without risk factors. There is no need to
send investigations on infants who are not ill. If there are multiple risk
factors, or a previous child has been affected by Group B streptococcal sepsis
many would consider blood culture and starting antibiotics appropriate.
Usually contracted at birth.
Routine antenatal screening detects maternal carrier state (hepatitis B (HBsAg)
+ve). Transmission risk 710% if mother is a low-risk carrier, (i.e. anti-HBe
+ve). To reduce vertical transmission give hepatitis B vaccine to infant within
24hr of birth. Also give specific
hepatitis B immunoglobulin 200IU IM if
mother is a high-risk carrier, (i.e. mother HBeAg +ve, or, anti-HBe –ve,
or, antibody/antigen status unknown), since the untreated transmission risk is
90%. In both groups, subsequent hepati-tis B vaccine is required at 1, 2, and
12mths (UK schedule).
Vertical transmission rate
715–25%. Risk markedly reduced by:
•
Maternal
antiretroviral drug therapy to minimize viral load during third trimester and
labour and then postnatal treatment of baby for 6wks.
•
Elective
lower segment Cesarean section (LSCS).
•
Avoidance
of breastfeeding (in developed world).
Infants are usually asymptomatic
at birth. Test at birth and 3 and 6mths for:
•
HIV
viral PCR;
•
P24
antigen;
•
specific
IgA.
Infection is very unlikely if all
negative at 6mths and baby well.
85% of neonatal HSV is contracted
at birth from active maternal genital le-sions. Elective LSCS reduces
transmission if mother has active genital
her-pes. Treat infant with prophylactic IV aciclovir if born by vaginal
delivery and there is primary
maternal herpes (transmission risk of 50% compared with 3% in secondary
herpes). To prevent infection from carers with cold sores, the lesions should
be covered with a mask and the sores treated with topical aciclovir.
Perinatal infection can cause
severe disseminated disease with high mortal-ity (30%) if:
•
Maternal
rash occurs in the period between 7 days antenatally and 7 days postnatally;
•
A LBW
infant (<1mth old) has contact with varicella and whose mother is non-immune
(i.e. check maternal antibody status if unsure).
Oral aciclovir and specific zoster
immunoglobulin (ZIG) 100mg IM given
soon after delivery.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.