Contents

#### **Preface XI**


Chapter 6 **Immunoglobulins in the Prevention and Treatment of Neonatal Sepsis 81**  Elisabeth Resch and Bernhard Resch

Preface

neonatology.

Neonatal bacterial infection and sepsis are clinical syndromes characterized by systemic signs of infection associated with bacteraemia within the first month of life. There are two patterns of disease with different spectrums of causative agents, earlyand late-onset sepsis. Neonatal sepsis still remains a significant cause of morbidity and mortality in the newborn, particularly in preterm, low birth weight infants [Stoll and Hansen 2003]. Despite advances in neonatal care, overall case-fatality rates from sepsis range from 3% to as high as 50% [Palazzi 2001]. Clinical signs of bacterial infection are vague and non-specific, and up to now there exists no easily available, reliable marker of infection despite a large bulk of studies focussing on inflammatory indices in

Bacterial pathogens that cause neonatal infections include Group-B-Streptococci (GBS), Escherichia coli, Haemophilus influenzae, Enterococci, Listeria monozytogenes, Streptococcus viridans, Streptococcus pneumoniae, and Staphylococcus aureus as the most common ones for early-onset infections and coagulase-negative Staphylococci (CONS), E.coli, Enterococci, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus viridans for late-onset infections. The identity of each may be suggested by timing of infection, presentation of signs and symptoms, and response to empirically prescribed antibiotics. For all organisms, successful management requires thorough, thoughtful assessment of risk factors, complete and careful clinical and laboratory studies, and prompt initiation of antibiotics and supportive treatment.

Every neonatologist is faced with the uncertainty of under- or over- diagnosing bacterial infection, and positive blood cultures are not the "philosopher´s stone" per se. As a result many neonates and especially those born preterm receive empiric antibiotic therapy, and the longer they are treated the more resistant pathogens develop in case of unconfirmed infection. If the clinical picture combined with a negative culture result allows justification of the neonate as being not infected

In this book three topics will be discussed: clinical presentation including a general approach to "sepsis neonatorum" and two distinct diagnoses – pneumonia and

antibiotics should be terminated as early as possible.
