Neonatal Tetanus

Neonatal sepsis is systemic infection during the neonatal period. Early onset disease usually reflects vertical acquisition; late onset disease increasingly reflects environmental or healthcare exposure.

Clinical manifestations are frequently subtle and nonspecific.

• Poor feeding
• Reduced activity
• Fever or hypothermia
• Apnoea
• Respiratory distress
• Vomiting
• Abdominal distension
• Jaundice
• Seizures
• Bulging fontanelle
• Shock

Temperature 38°C or greater or below 35.5°C, severe chest indrawing and poor feeding are important warning features.

Obtain:

• Blood culture
• FBC
• CRP or other inflammatory markers
• Glucose

Lumbar puncture should be performed where meningitis is suspected or systemic sepsis is significant and the neonate is stable enough.

Do not delay antibiotics in a critically ill neonate.

• Maintain warmth.

• Correct hypoglycaemia.

• Give oxygen for hypoxaemia.

• Provide enteral feeds or IV fluids according to clinical stability.

Empirical therapy should cover major neonatal pathogens.

A commonly used regimen is:

Benzylpenicillin plus gentamicin IV.

Where staphylococcal infection, extensive skin pustules, abscess or omphalitis is suspected, use appropriate antistaphylococcal cover such as flucloxacillin plus gentamicin.

Suspected meningitis requires meningitic antibiotic dosing and an agent with adequate CSF penetration.