Anemia of Prematurity - Portal Neonatal

o The clinician may require different antibiotic choice, dosage, and/or treatment time if the
infant has bacterial meningitis. Perform a follow-up lumbar puncture within 24-36 hours
after antibiotic therapy has been initiated to determine if the CSF is sterile. If organisms
are still present, modification of drug type or dosage is required to adequately treat the
meningitis. Continue antibiotic treatment for 2 weeks after sterilization of the CSF or for a
minimum of 2 weeks for gram-positive meningitis and 3 weeks for gram-negative
meningitis, whichever period is longest. Chloramphenicol or trimethoprimsulfamethoxazole
has been shown to be effective in the treatment of highly resistant
bacterial meningitis.
• Granulocyte transfusion has been shown to be suitable for infants with significant depletion of
the storage neutrophil pool; however, the documentation of storage pool depletion requires a
bone marrow aspiration, and the granulocyte transfusion must be administered quickly to be
beneficial. The number of potential adverse effects, such as graft versus host reaction,
transmission of CMV or hepatitis B, and pulmonary leukocyte sequestration, is considerable.
Therefore, this therapy remains an experimental treatment.
• IVIG has been considered for neonatal sepsis to provide type-specific antibodies to improve
opsonization and phagocytosis of bacterial organisms and to improve complement activation
and chemotaxis of neonatal neutrophils; however, difficulties with IVIG therapy for neonatal
sepsis exist. The effect has been transient, and adverse effects associated with the infusion
of any blood product can occur. Dose-related problems with this therapy decrease its
usefulness in neonatal populations.
• Recombinant human cytokine administration to stimulate granulocyte progenitor cells has
been studied as an adjunct to antibiotic therapy. These therapies have shown promise in
animal models, especially for GBS sepsis, but require pretreatment or immediate treatment
to demonstrate efficacy. The use of granulocyte-macrophage colony-stimulating factor (GM-
CSF) and granulocyte colony-stimulating factor (G-CSF) has been studied in clinical trials,
but their use in clinical neonatology remains experimental.
• The infant with sepsis may require treatment aimed at the overwhelming systemic effects of
the disease. Cardiopulmonary support and intravenous nutrition may be required during the
acute phase of the illness until the infant's condition stabilizes. Monitoring of blood pressure,
vital signs, hematocrit, and platelets is vital.
Surgical Care: If hydrocephalus associated with neonatal meningitis occurs, and progressive
accumulation of CSF is present, placing a ventriculoperitoneal (VP) shunt may be necessary to drain
off the excess fluid. The immediate complications of shunt placement are overdrainage, equipment
failure, disconnection, migration of catheter, or shunt infection. Abdominal obstruction, omental cysts,
and perforation of the bladder, gall bladder, or bowel occur infrequently. The VP shunt may cause
long-term neurologic complications, including slit-ventricle syndrome, seizures, neuroophthalmological
problems, and craniosynostosis; however, the outcome for children with VP shunt
placement is generally good with careful follow-up.
Consultations:
• Infectious disease consultation is useful, especially if the infant is not responding to treatment
and/or if an unusual clinical sign is present, such as an unknown rash.
• If neonatal meningitis is identified, consultation with a pediatric neurologist may be necessary
for assistance with the initial short-term care or for subsequent outpatient follow-up of
neurologic sequelae.
• Consultation with a pediatric pharmacologist may be helpful for advice on dosage and/or
antibiotic changes that are necessary because of inadequate or toxic levels obtained with
therapeutic monitoring.
Diet: The neonate may need to be given nothing by mouth (NPO) during the first days of treatment
because of gastrointestinal symptoms or poor feeding. Consider parenteral nutrition to ensure that
the patient's intake of calories, protein, minerals, and electrolytes is adequate during this period.
Feeding may be restarted via a nasogastric tube for the infant with serious compromise. Encourage
that breast milk be given because of the immunologic protection it provides.