Contents Chapter Topic Page Neonatology Respiratory Cardiology

Antibiotic choice will depend on prevailing infecting organisms and their sensitivities. A
carbapenem and vancomycin are often used in units where ESBL and MRSA/MRSE are
common
- Add metronidazole if intra-abdominal sepsis or NEC present.
- Consider fungal septicaemia if child does not respond especially preterm with or without
long lines and usage of TPN.
Adjust final antibiotics according to C&S results.
Duration of therapy:
- If cultures are negative and infection is clinically unlikely after further review, off
antibiotics by 48-72 hours.
- If proven infection: 10 days for septicaemia, 7-14 days for pneumonia and 14 to 21
days for meningitis and septicaemia
2. Supportive Measures
i) Monitoring: Temp, fluid balance, weight, hydration state, ABG
ii) Temperature control
- servo - controlled incubator is contraindicated as it will affect temperature
recording.
- maintain environment temp at top end or above the normal thermoneutral range.
iii) Treatment of Shock - hypotension esp. in Gram-neg. septicaemia.
- Keep MAP to around Gestation + 5 mmHg
- May need to transfuse albumin or FFP (Albumin 25% give 4 ml/kg made up with
NaCl to 20 ml/kg)
- Start inotropes ( dopamine / dobutamine/adrenaline or noradrenalin) as indicated
iv) Removal of central lines - Remove UAC or UVC in NEC or other abdominal sepsis.
Also consider removal of UAC, UVC and peripherally –inserted central venous catheter if
sepsis is not readily cleared
v) If DIVC occurs
- Check APTT, PT, Platelet count
- treat with FFP/cryoprecipitate/platelet or blood transfusion as indicated
Prevention
The prevention of cross infections in the NNU is of utmost importance. The most
effective preventive measure is hand washing. Other infection control measures e.g.
aseptic techniques in patient procedures must also be strictly adhered to.
References:
N.R.C. Roberton. Textbook of Neonatology. Churchill Livingstone