성장을 멈추지 마세요

체험은 만족하셨나요?

현재 45,766명이 마이메르시로 공부 중이에요

지식 자료를 소장하고 멋진 의료인으로 성장하세요

학습 자료 둘러보기 →
Sepsis | 마이메르시 MyMerci
제안하기

뭔가 하고 싶은 말이 있는거야?

0 / 2000
컨텐츠 수정하기

컨텐츠 내용을 수정할 수 있습니다

수정하기
닫기

Sepsis

NCLEX Review Guide: Neonatal Sepsis

Pathophysiology of Neonatal Sepsis

Definition and Classification

  • Neonatal sepsis is a systemic inflammatory response syndrome (SIRS) in the presence of or as a result of suspected or proven infection in a neonate. It is classified as early-onset sepsis (EOS) occurring within the first 72 hours of life, or late-onset sepsis (LOS) occurring after 72 hours up to 28 days of life.
  • Early-onset sepsis is primarily associated with organisms transmitted from the maternal genital tract, while late-onset sepsis is associated with organisms acquired from the environment after birth.

Key Points

  • Early-onset sepsis (≤72 hours) vs. Late-onset sepsis (>72 hours to 28 days)
  • Maternal vertical transmission is the primary cause of EOS
  • Environmental and nosocomial sources are the primary causes of LOS

Common Causative Organisms

  • Early-onset sepsis is commonly caused by Group B Streptococcus (GBS), Escherichia coli, and Listeria monocytogenes. The implementation of intrapartum antibiotic prophylaxis has significantly reduced the incidence of GBS sepsis.
  • Late-onset sepsis is frequently caused by Coagulase-negative staphylococci, Staphylococcus aureus, Escherichia coli, Klebsiella, and Pseudomonas species. NICU patients are particularly vulnerable to nosocomial infections.

Common Pathogens in Neonatal Sepsis

Early-Onset Sepsis (EOS) Late-Onset Sepsis (LOS)
Group B Streptococcus (GBS) Coagulase-negative staphylococci
Escherichia coli Staphylococcus aureus
Listeria monocytogenes Escherichia coli
Enterococcus Klebsiella species
Haemophilus influenzae Pseudomonas species

Key Points

  • GBS and E. coli are the leading causes of EOS
  • Coagulase-negative staphylococci are the most common cause of LOS
  • Intrapartum antibiotic prophylaxis has reduced GBS sepsis rates

Risk Factors

  • Maternal risk factors include prolonged rupture of membranes (>18 hours), maternal fever (>38°C), chorioamnionitis, maternal GBS colonization without adequate intrapartum antibiotic prophylaxis, and urinary tract infection.
  • Neonatal risk factors include prematurity, low birth weight, male gender, congenital anomalies, invasive procedures (central lines, endotracheal tubes), and prolonged hospital stay.

Key Points

  • Premature and low birth weight infants are at highest risk for sepsis
  • Prolonged rupture of membranes (>18 hours) significantly increases risk
  • Invasive procedures increase risk of LOS

Clinical Manifestations and Assessment

Clinical Presentation

  • Signs of neonatal sepsis are often subtle and nonspecific, making early diagnosis challenging. Initial symptoms may include temperature instability (hypothermia or hyperthermia), respiratory distress, feeding intolerance, lethargy, and irritability.
  • As sepsis progresses, more severe manifestations may develop, including apnea, cyanosis, jaundice, hepatomegaly, seizures, and signs of shock (poor perfusion, hypotension, prolonged capillary refill).

Clinical Scenario

A 3-day-old term infant who was previously feeding well begins to exhibit temperature instability, decreased activity, and poor feeding. The infant appears mottled with mild respiratory distress and a capillary refill of 3 seconds. The mother had prolonged rupture of membranes (20 hours) prior to delivery but received only one dose of intrapartum antibiotics. These signs warrant immediate sepsis evaluation.

Key Points

  • Signs of neonatal sepsis are often subtle and nonspecific
  • Temperature instability, poor feeding, and lethargy are early warning signs
  • Any change in a neonate's baseline condition should raise suspicion for sepsis

Diagnostic Evaluation

  • The gold standard for diagnosis is a positive blood culture, though cultures may be negative in up to 60% of clinically septic neonates. A complete sepsis workup includes blood culture, complete blood count (CBC) with differential, C-reactive protein (CRP), and often cerebrospinal fluid (CSF) analysis.
  • Additional laboratory findings may include thrombocytopenia, leukopenia or leukocytosis, elevated immature-to-total neutrophil (I:T) ratio >0.2, metabolic acidosis, hypoglycemia or hyperglycemia, and elevated procalcitonin levels.

Memory Aid: SEPSIS Assessment

  • S - Skin changes (mottling, poor perfusion)
  • E - Eating changes (feeding intolerance)
  • P - Perfusion changes (prolonged capillary refill)
  • S - Screening labs (CBC, CRP, blood culture)
  • I - Instability (temperature, respiratory, heart rate)
  • S - Subtle changes in behavior (lethargy, irritability)

Key Points

  • Blood culture is the gold standard but may be negative in true sepsis
  • I:T ratio >0.2 and CRP are helpful indicators of infection
  • Serial CRP measurements are more valuable than a single measurement

Management and Nursing Care

Antimicrobial Therapy

  • Empiric antibiotic therapy should be initiated promptly when sepsis is suspected, without waiting for culture results. The typical regimen for EOS is ampicillin plus gentamicin, which covers the most common pathogens.
  • For LOS, empiric coverage often includes vancomycin plus an aminoglycoside or third-generation cephalosporin to target hospital-acquired pathogens. Antibiotic therapy is adjusted based on culture results and continued for 7-14 days depending on the pathogen and clinical response.

    Administering IV Antibiotics to Neonates

  1. Verify the antibiotic order, dose, route, and patient identification
  2. Calculate the dose based on the neonate's weight (mg/kg)
  3. Prepare the medication using aseptic technique
  4. Dilute to appropriate concentration for neonatal administration
  5. Administer via infusion pump at the prescribed rate
  6. Monitor the IV site for signs of infiltration or phlebitis
  7. Assess the neonate for adverse reactions during administration
  8. Document administration, site condition, and patient response

When administering gentamicin or vancomycin to neonates, therapeutic drug monitoring is essential to prevent ototoxicity and nephrotoxicity. Collect peak and trough levels at appropriate times.

Key Points

  • Empiric antibiotics should be started immediately when sepsis is suspected
  • Ampicillin + gentamicin is the standard regimen for EOS
  • Antibiotic therapy should be narrowed based on culture results

Supportive Care

  • Supportive care includes maintaining thermoregulation, ensuring adequate oxygenation and ventilation, supporting cardiovascular function, correcting metabolic abnormalities, and providing appropriate nutrition and hydration.
  • Severely affected neonates may require mechanical ventilation, inotropic support for hypotension, and management of disseminated intravascular coagulation (DIC) or other complications.

Key Points

  • Maintain neutral thermal environment to reduce metabolic demands
  • Monitor vital signs and cardiorespiratory status frequently
  • Provide respiratory support as needed (oxygen, CPAP, mechanical ventilation)

Nursing Care and Monitoring

  • Nursing care focuses on frequent assessment of vital signs, cardiorespiratory status, perfusion, and neurological status. Strict infection control practices are essential to prevent nosocomial spread, including proper hand hygiene, aseptic technique for procedures, and care of invasive devices.
  • Nurses must monitor for signs of clinical deterioration or improvement, administer medications accurately, maintain fluid and electrolyte balance, and provide developmentally supportive care to minimize stress.

Neonatal Sepsis Nursing Priorities: "ABCDEF"

  • Airway and Antibiotic administration
  • Breathing and Blood pressure support
  • Circulation and Continuous monitoring
  • Developmental care and Documentation
  • Education of parents and Evidence collection (labs)
  • Fluid management and Feeding support

Key Points

  • Strict hand hygiene and infection control are essential
  • Monitor for subtle changes in condition that may indicate deterioration
  • Provide family-centered care with education and emotional support

Prevention and Complications

Prevention Strategies

  • Prevention of EOS primarily involves intrapartum antibiotic prophylaxis for GBS-positive mothers or those with risk factors. The CDC recommends universal screening of pregnant women at 35-37 weeks gestation for GBS colonization.
  • Prevention of LOS focuses on infection control practices in the NICU, including proper hand hygiene, minimal handling, aseptic technique for procedures, care of central lines, and judicious use of antibiotics to prevent resistance.

Key Points

  • Intrapartum antibiotic prophylaxis has reduced GBS EOS by 80%
  • Hand hygiene is the single most important measure to prevent LOS
  • Central line care bundles reduce catheter-associated infections

Complications and Outcomes

  • Acute complications of neonatal sepsis include respiratory failure, shock, DIC, meningitis, and multi-organ dysfunction syndrome. Mortality from neonatal sepsis ranges from 5-20%, with higher rates in premature and very low birth weight infants.
  • Long-term complications may include neurodevelopmental impairment, cerebral palsy, hearing loss, visual impairment, and chronic lung disease. The risk of adverse outcomes is highest in infants with meningitis or prolonged septic shock.

Neonatal meningitis is a serious complication of sepsis with high morbidity. Always consider performing a lumbar puncture as part of the sepsis workup, especially in symptomatic infants, before starting antibiotics when possible.

Key Points

  • Mortality is highest in premature and very low birth weight infants
  • Prompt recognition and treatment improve outcomes
  • Long-term neurodevelopmental follow-up is essential for survivors

Summary of Key Points

  • Classification: Early-onset sepsis (≤72 hours) is typically caused by maternal vertical transmission (GBS, E. coli), while late-onset sepsis (>72 hours to 28 days) is often caused by environmental or nosocomial pathogens (coagulase-negative staphylococci).
  • Risk factors: Maternal factors include prolonged rupture of membranes, chorioamnionitis, and inadequate GBS prophylaxis. Neonatal factors include prematurity, low birth weight, and invasive procedures.
  • Clinical manifestations: Signs are often subtle and nonspecific, including temperature instability, respiratory distress, feeding intolerance, lethargy, and poor perfusion.
  • Diagnosis: Blood culture is the gold standard but may be negative. CBC with differential, CRP, and CSF analysis are important diagnostic tools.
  • Management: Prompt empiric antibiotic therapy (ampicillin + gentamicin for EOS; vancomycin + aminoglycoside/cephalosporin for LOS) and supportive care are essential.
  • Prevention: Intrapartum antibiotic prophylaxis for GBS, strict infection control practices, and central line care bundles are key preventive strategies.

Commonly Confused Points

Commonly Confused Concepts in Neonatal Sepsis

Concept Common Misconception Correct Understanding
Early vs. Late Onset Sepsis EOS occurs in the first week of life EOS occurs in the first 72 hours, while LOS occurs after 72 hours up to 28 days
Fever in Neonates Fever is always present in sepsis Neonates may present with hypothermia rather than fever during sepsis
Antibiotic Duration All sepsis requires 14 days of antibiotics Duration depends on pathogen, site of infection, and clinical response (7-14 days typical)
Negative Blood Culture Negative culture rules out sepsis Blood cultures may be negative in up to 60% of clinically septic neonates
Meningitis Evaluation Lumbar puncture is only needed for symptomatic infants LP should be considered in all neonates with suspected sepsis, as meningitis can occur without specific neurological signs

Key Points

  • Temperature instability in neonates includes both hyperthermia AND hypothermia
  • Negative blood cultures do not rule out sepsis
  • Antibiotic duration should be individualized based on clinical picture and culture results

Study Tips

Memory Aids for Neonatal Sepsis

Risk Factors for Neonatal Sepsis: "SEPSIS"

  • Small for gestational age/prematurity
  • Early rupture of membranes (prolonged)
  • Procedures (invasive)
  • Streptococcus Group B maternal colonization
  • Infection (maternal)
  • Skin integrity compromised

Signs of Neonatal Sepsis: "INFECTION"

  • Instability of temperature
  • Nutritional challenges (poor feeding)
  • Fatigue and lethargy
  • Episodes of apnea/bradycardia
  • Color changes (mottling, cyanosis)
  • Tachycardia or tachypnea
  • Irritability or inconsolability
  • Oxygen requirement increased
  • Not perfusing well (prolonged capillary refill)

Early-Onset Sepsis Pathogens: "GEL"

  • Group B Streptococcus
  • Escherichia coli
  • Listeria monocytogenes

NCLEX Practice Strategies

  • Focus on recognizing subtle signs of neonatal sepsis in clinical scenarios. The NCLEX often tests the ability to identify early, nonspecific signs rather than obvious septic shock.
  • Practice prioritizing nursing interventions for a septic neonate. Remember that airway, breathing, and circulation always come first, followed by antibiotic administration and supportive care.
  • Review laboratory value interpretation, particularly CBC with differential, I:T ratio, CRP, and CSF findings in neonatal sepsis.

Key Points

  • Use memory aids to recall risk factors and clinical manifestations
  • Practice identifying subtle signs of sepsis in clinical scenarios
  • Focus on prioritization of nursing care for the septic neonate

Self-Assessment Checklist









Quick Check

A 2-day-old term infant presents with poor feeding, temperature instability, and tachypnea. The mother had prolonged rupture of membranes for 24 hours before delivery. What is the most appropriate initial antibiotic regimen?

Answer: Ampicillin plus gentamicin (This covers the most common EOS pathogens including GBS and E. coli)

Common Pitfalls

Don't wait for confirmation of infection before starting antibiotics in a neonate with suspected sepsis. Early empiric treatment is essential for improved outcomes.

Don't forget to consider meningitis in all cases of neonatal sepsis, as CNS involvement may occur without obvious neurological signs.

Remember, early recognition and prompt intervention are key to improving outcomes in neonatal sepsis. Trust your nursing assessment skills and don't hesitate to advocate for your tiny patients when you notice even subtle changes in their condition. You've got this!

다음 이론을 계속 학습하려면 로그인하세요.

로그인하고 계속 학습
컨텐츠를 그만볼래?

필기노트, 하이라이터, 메모는 잘 쓰고 있어?

내보내줘
어떤 폴더에 저장할래?

컨텐츠 노트에는 총 0개의 폴더가 있어!

폴더 만들기
컨텐츠 만들기
만들기
신고했어요.

운영진이 검토할게요!

해당 유저를 차단했어요.

마이페이지에서 차단한 회원을 관리할 수 있어요.