Clerkship Ready: Pediatrics

Sepsis is a clinical syndrome in which an infection leads to an inflammatory response throughout the body that rapidly progresses to organ dysfunction or even death. Worldwide, neonatal sepsis affects 2,202 infants per 100,000 live births, and has a mortality rate of >11%. In the United States, early onset sepsis affects 50 in 100,000 live births, with a mortality rate of about 3%. So it’s a big problem that we don’t want to miss. In this episode, we will define neonatal sepsis, talk about the presentation of sepsis, what a sepsis workup entails, how to make the diagnosis and treatment of neonatal sepsis.

1. Defining Neonatal Sepsis
   
   
   1. Early Onset Sepsis
   
   
   2. Late Onset Sepsis
   
   



2. Neonatal Early Onset Sepsis Calculator - https://neonatalsepsiscalculator.kaiserpermanente.org/


3. Presentation of Illness and Physical Exam


4. Pathogenesis
   
   
   1. Group B Strep
      
      
      1. Screening and prophylaxis
      
      
   
   
   
   2. E coli
   
   
   3. Strep viridans
   
   
   4. Klebsiella
   
   
   5. Enterococcus
   
   
   6. Listeria
   
   
   7. HSV
      
      
      1. Screening and prophylaxis
      
      
   
   
   



5. Types of Infection
   
   
   1. Bacteremia
   
   
   2. Pneumonia
   
   
   3. Meningitis
   
   



6. Work up
   
   
   1. CBC with differential
   
   
   2. Blood Culture
   
   
   3. Urinalysis and Urine Culture
   
   
   4. Cerebrospinal Fluid culture
   
   
   5. Chest X-Ray
   
   
   6. Surface swabs of mucous membranes
   
   



7. Antimicrobial coverage


8. Evaluation and Treatment of a Well Appearing Febrile Infant 8-60 days old
   
   
   1. https://doi.org/10.1542/peds.2021-052228
   
   
   2. 8-21 days
   
   
   3. 22-28 days
   
   
   4. 29-60 days
   
   

References:

1. Neonatal Early Onset Sepsis Calculator - https://neonatalsepsiscalculator.kaiserpermanente.org/


2. AAP Guidelines for Evaluation and Treatment of a Well Appearing Febrile Infant 8-60 days old: https://doi.org/10.1542/peds.2021-052228