SEPSIS PADA BAYI BARU LAHIR

The Baby’s
Adaptation to Labor
and Delivery

Newborn’s
appearance
 Pendahuluan

• Masa Bayi Baru Lahir ( BBL ) : rawan ,

penyesuaian fisiologik  hidup sebaik-
baiknya di luar kandungan
• Kehidupan intrauterinekstrauterin :
perubahan biokimia dan faali
• Faktor gangguan a.l : prematuritas, ke-
lainan anatomis, lingkungan dlm kan-
dungan/persalinan/sesudah lahir
 Neonatal sepsis
• Clinical syndrome of bacteremia with
systemic signs and symptoms of infection
in the first four weeks of life
 DEFINISI
• Sepsis adalah infeksi aliran darah yang bersifat
invasif dan ditandai dengan ditemukannya
bakteri dalam cairan tubuh seperti darah, cairan
sumsum tulang atau air kemih
• Sering terjadi pd bayi resiko : BKB, BBLR,
Sindroma Ggn Nafas, lahir dari ibu berisiko

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Dr.Bambang M 15/06/1999
• Pembagian :
- sepsis awitan dini
- sepsis awitan lambat
• Sepsis awitan dini : di bawah 3 hari. Terjadi
secara vertikal dari ibu hamil, selama persalinan/
kelahiran
• Sepsis awitan lambat : > 3 hari, kuman dari
lingkungan, horizontal, nosokomial

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Dr.Bambang M 15/06/1999
 Early vs Late onset sepsis
Early Late

 Onset < 72 hrs > 72 hrs

 Source Maternal  Environmental

genital tract (nosocomial)
 Maternal
genital tract
bad late
manifestation
 Beberapa istilah

• Sepsis  sindroma respon inflamasi sistemik (Systemic

Inflamatory Respons Syndrome – SIRS) yg terjadi akibat
infeksi bakteri, virus, jamur, parasit.
• Sepsis berat : disertai disfungsi organ kardiovaskuler dan
ggn nafas akut atau terdapat ggn dua organ lain (
neurologi, hematologi, urogenital, dan hepatologi )
• Syok sepsis terjadi bila masih dlm keadaan hipotensi
walau telah mendapatkan cairan adekuat/cukup )
• Sindroma disfungsi multi organ : bayi tidak mampu lagi
mempertahankan homeostasis tubuh terjadi perubahan
fungsi dua atau lebih organ tubuh.

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Dr.Bambang M 15/06/1999
 Etiology

• Mostly gram negative

• Neonatal ward RSCM 2001 :
– Acinebacter ; Enterobacter ; Escherichia
coli; Klebsiella pneumoniae ; Pseudomonas.
 Symptoms of neonatal sepsis

• CNS
• Lethargy, refusal to suckle, limp, not arousable,
poor or hight pitched cry, irritable, seizures

• CVS
• Pallor, cyanosis, cold, clammy skin

• Respiratory
• Tachypnea, apnea, grunt, retractions
 …Symptoms of neonatal sepsis

• GIT
• Vomiting, diarrhoea, abdominal distension

• Hematological
• Bleeding, jaundice

• Skin
• Rashes, purpura,pustules
 Signs of neonatal sepsis

Cold to touch (hypothermia)

Poor perfusion ( CRT)
Hypotension
Renal failure
Sclerema
Bulging fontanelle, neck retraction
Poor weight gain*
 Diagnosis

• Masalah : gambaran klinis tidak spesifik

tanda/gejala = peny.non infeksi ( sin. gn
nafas, perdarahan intrakranial, gjl sepsis
klasik ( pd anak besar) jarang pd bayi
• Baku emas : biakan darah
• Pemeriksaan penunjang : C reactive
protein, biomolekuler, respon imun/sitokin
?
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Dr.Bambang M 15/06/1999
 Practical “sepsis screen”

1. Leukopenia (TLC < 5000/mm3)

2. Neutropenia (ANC < 1800/mm3)
3. Immature neutrophil to total neutrophil
(I/T) ratio (>0.2)
4. CRP + ve
 Diagnosis ( lanj.)

• Beberapa informasi yg diperlukan :

- faktor resiko ( pd awitan dini/ lambat)
- gambaran klinik
- pemeriksaan penunjang
• Faktor resiko awitan dini :
- faktor ibu : persalinan dan kelahiran kurang
bulan, ketuban pecah lebih dari 18-24 jam,
chorioamnionitis, persalinan dg tindakan,
demam pd ibu (> 38.4 C ), infeksi sal.kencing
ibu, faktor sosial dan gizi ibu.
- faktor bayi : asfiksia perinatal, lahir rendah,
kurang bulan, prosedur infasif, cacat bawaan
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Dr.Bambang M 15/06/1999
 Diagnosis ( lanj.)

• Faktor resiko sepsis awitan lambat :

- dirawat di ruang intensif, perawatan lama,
nutrisi parenteral lama, dari alat perawatan bayi,
infeksi nosokomial dari bayi lain/ perawat

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Dr.Bambang M 15/06/1999
 Supportive care

Keep the neonate warm

Start IV, infuse 10 % dextrose 2 ml/kg stat to
maintain normoglycemia
Maintain fluid and electrolyte balance and
tissue perfusion. If CRT > 3 sec infuse 10
ml/kg normal saline
………... Supportive care

Avoid enteral feed, if sick

Start oxygen by hood, if cyanosed and
support breathing
Consider exchange blood transfusion, if there
is sclerema
10-15 percent cases of sepsis have
meningitis
Meningitis can be often missed clinically
LP must be done in all cases of late onset
sepsis
 Choice of Antibiotics
Pneumonia or Sepsis
Penicillin Aminoglycoside
(Ampicillin or Cloxacillin) (Gentamicin or
Amikacin)

Meningitis

Apicillin + Gentamicin + Chloramphenicol

or
Gentamicin or Amikacin + Cefotaxime
 Suspected neonatal sepsis
* Start parenteral antibiotics
* Send cultures (report in 72 hrs.)

Culture - ve Culture + ve

Clinically Clinically ill Culture + ve

well
(Cont Ab x 7 - 10D)
(Stop Ab)

Pneumonia, Sepsis Meningitis, Osteomyelitis

(Cont Ab x 7 - 10 D)
 Superficial infections

 Pustules  After puncturing, clean with

betadine and apply local
 Conjunctivitis antimicrobial
 Chloramphenicol eye drops
 Oral thrush
 Local application of nystatin or
Clotrimazone
 Prevention of infections

• Exclusive breastfeeding
• Keep cord dry
• Hand washing by care givers
• Hygiene of baby
• No unneccessary interventions
Control of hospital infections

• Handwashing by all staff

• Isolation of infectious patient
• Use plenty of disposable items
• Avoid overcrowding
• Aseptic work culture
• Infection surveillance
Selamat belajar
PATHOPHYSIOLOGY OF
INFLUENZA
Pathophysiology
• Binding and destruction of epithelial cells from
nasopharynx to alveoli
Droplets

LOCAL INFLAMMATORY REACTION

Upper respiratory infection Body
response

SYSTEMIC BODY REACTION

Fever, muscle pain, etc.

Aymard M. Vaccine 1995: 47–70.

Uncomplicated influenza
Incubation period
(RMKTCID 50/ml)

Virus isolation
nasopharyngeal

Fever curve 41

temperature (°C)
virus titer

5
LOG10

Oral
3 39
2
1
0 37
Time in days 0 1 2 3 4 5 6 7 8 9 10

Sore throat, myalgia

Headache
Cough
Coryza
Malaise, prostration
Complications
Onset of illness
Kilbourne ED. Influenza. New York: Plenum Medical Book Company; 1987: 156–218.
Overview – clinical symptoms
• Abrupt onset of symptoms
• Abrupt onset of fever, drop in temperature
after 2 days, increase again
• Severe myalgia
• Sore throat
• Dry cough
• Retrosternal pain
• Severe malaise lasting several days
Symptoms of influenza
Cough
Malaise
Feverishness
Sudden onset
Chills
Headache
Anorexia
Coryza
Myalgia
Sore throat
Sputum
Dizziness
Hoarseness
Chest pain
Vomiting
Diarrhoea
Abdominal pain
Fever > 37.8°C
0 10 20 30 40 50 60 70 80 90 100
Percentage of cases
Nicholson KG et al., eds. Textbook of Influenza. Malden, Massachusetts: Blackwell Science; 1998.
Fulminant influenza
• Reported during pandemics
• The fulminant form can affect everyone
• Pulmonary manifestation
• Antibiotics are ineffective
• Influenza viral pneumonia

Fever
Cough
Dyspnoea
DEATH
Cyanosis

Aymard M. Vaccine 1995: 47–70.

By courtesy of APACI
Asia-Pacific Advisory Committee on influenza
www.apaci-flu.com