Contents Chapter Topic Page Neonatology Respiratory Cardiology

Always:
1. FBC: Hb, TWBC with differential count, Platelet.
There is normally a leucocytosis up to 30 x10 9 /L at birth.
Indicators of infection:
1st day - Neutropenia; immature cells & toxic granulation
Beyond 3 days- Polymorph > 7.5-8.0x10 9 /L or < 2x10 9 /L
Monocytes > 0.8 x 10 9 /L
Both thrombocytopenia and thrombocytosis may implicate infection
2.. Blood C&S
When available:
1. C reactive protein (CRP) : A raised CRP is presumptive of infection and will help in
deciding on the start of antibiotics if clinical picture is uncertain till the result of culture and
sensitivity is available. It may also help in deciding on the duration of antibiotic therapy.
When indicated :
1. Lumbar Puncture (CSF biochemistry, microscopy, latex agglutination for bacterial
antigen and culture and sensitivity)
2. CXR
3. AXR
4. Maternal HVS C&S (Ring up postnatal ward to see if it has been done)
5. Culture of ETT aspirate
6. Culture of tip of IV cannula / umbilical catheters.
7. Urine FEME and C&S / SPA urine C&S
8. ABG
Treatment
1. Antibiotics
- Start immediately when diagnosis is suspected and after all appropriate specimens
taken. Do not wait for C&S result!
Recommended Empiric Therapy:
For early-onset infection:
IV Penicillin and IV Gentamycin to cover for GBS and Pneumococci. / Gram negative
organisms (Use high dose Penicillin 100,000U/kg)
For late-onset community acquired infection:
IV Cloxacillin and Gentamycin to cover for Staphylococci / Gram negative organisms in
non-CNS sepsis, cefotaxime and penicillin for CNS infection
For nosocomial (hospital acquired) infections: