All of the previously discussed diagnostic principles of SIRS and sepsis may be
applied to the neonatal population, but need to be supplemented by examination
findings, particular to this group of patients.[ 29 ] Certain physical exam findings
are subtle and may precede any of the physiologic derangements. These include
temperature instability, apnea, bradycardia (<100 bpm), respiratory distress in a
previously stable patient as manifested by grunting, retractions, tachypnea, and
hypoxemia). Additional findings include feeding intolerance or poor feeding,
irritability, decreased responsiveness, poor suck, decreased tone, weak cry,
mottled and cool skin, and acute hypoglycemia or hyperglycemia. Certainly, any
of these symptoms may be present in absence of an infection, whether as a
result of prematurity or expected transition to post-natal environment. As such,
they should be assessed in the context of each individual patient, along with their
risk factors for infection. This will assure that the therapy is applied appropriately
and responsibly, while avoiding a prolonged use of antimicrobials in otherwise
healthy patients.
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Figure 1: Treatment of Neonatal Sepsis
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Temperature instabiliRecognize warning signty, increased work of breathing,s of neonatal infection/sepsis RDS, apnea and :^
bradycardia, feeding intolerance.
within Startan hour of suspected infection. Provide supplemental O2^ infectious work-up and broad spectrum antibiotics and^
appropriate IV access. Stop feeds, if initiated previously. Give IV bolus of 10-20 ml of crystalloid.