**10. Principles of treatment**

Early Sepsis – Ampicillin + Gentamicin; Late Sepsis – Cefotaxime+ Aminoglycosides; Consequent A/B therapy depending on the results of repeated blood inoculation - Vancomycin and/or Meropenem and/or Antimycotic Drugs.

Early Detection and Prevention of Neonatal Sepsis 13

**Injection (hours)** 

48 34 24

36 24

**Injection (hours)** 

48 36 24

36 24

**Dosage of Antibiotics: Gentamicin** 

Injected intravenously slowly during 30 minutes.

30-34 0-7

Neofax 2009 Twenty Second Edition [14]

**Dosage of Antibiotics: Amikacin** 

**AMIKACIN** 

**Gestational Age (weeks.)** 

≤ 29

0-7 8-28 ≥ 29

≥ 8

**Postnatal Age** 

0-7 8-28 ≥ 29

≥ 8

≥ 35 All 15 24

**Table 2.** Therapeutic guidelines in neonatal infection 2011 [11]

Injected intravenously slowly during 30 minutes.

30-34 0-7

Neofax 2009 Twenty Second Edition [14,15]

**Table 3.** Therapeutic guidelines in neonatal infection 2011 [11]

**(weeks.) Postnatal Age (days) Dose (mg/kg) Interval between** 

≥ 35 All 4 24

5 4 4

4,5 4

**(days) Dose (mg/kg) Interval between** 

18 15 15

18 15

**GENTAMICIN** 

**Gestational Age**

≤ 29

It's important to consider local epidemiological/microbiological data.

Empyreal antibiotic therapy of early sepsis must impact on gram negative and gram positive microorganisms. It's important to remember that listerias are potential agents for early infection of neonates. It is necessary to prescribe 2 antibiotics which cover a wide enough spectrum and at the same time resist a selection of antibiotic resistant bacteria. In case of late hospital sepsis it is particularly important to affect staphylococcus and gram negative bacteria. If mother discharges GBS during delivery it is advised that penicillin be prescribed.

**Figure 6.** Therapeutic guidelines in neonatal infection 2011[11]

### **Duration of Antibacterial Therapy**

Absence of clinical symptoms and negative results of investigation: 48-72 hr; In case of gram + flora – 7 or more days; In case of gram + flora - minimum 14 days; In case of meningitis - 21 days; Consequent a/b therapy should depend on the results of repeated blood culture investigations.[12]

The duration of antibacterial therapy depends on clinical form of infection while therapy of osteomyelitis/endocarditis it is recommended to change antibiotics only in case of absence of effect of conducted therapy.

#### **Dosage of Antibiotics: Ampicilin**

AMPICILIN - Single dose 25-50 mg/kg IntraV/IntraM GBS Infection.

In cases of bacteria it is permitted- 150-200 mg/kg/day;

In cases of meningitis- 300- 400 mg/kg in a day


**Table 1.** Therapeutic guidelines in neonatal infection 2011 [11] Neofax 2009 Twenty Second Edition [14]

### **Dosage of Antibiotics: Gentamicin**

#### **GENTAMICIN**

12 Neonatal Bacterial Infection

**10. Principles of treatment** 

Vancomycin and/or Meropenem and/or Antimycotic Drugs.

**Figure 6.** Therapeutic guidelines in neonatal infection 2011[11]

AMPICILIN - Single dose 25-50 mg/kg IntraV/IntraM GBS Infection.

In cases of bacteria it is permitted- 150-200 mg/kg/day;

<sup>≤</sup> 29 0-28

30-36 0-14

37-44 0-7

**Table 1.** Therapeutic guidelines in neonatal infection 2011 [11]

Neofax 2009 Twenty Second Edition [14]

In cases of meningitis- 300- 400 mg/kg in a day

**Duration of Antibacterial Therapy** 

investigations.[12]

effect of conducted therapy.

**Dosage of Antibiotics: Ampicilin** 

It's important to consider local epidemiological/microbiological data.

Early Sepsis – Ampicillin + Gentamicin; Late Sepsis – Cefotaxime+ Aminoglycosides; Consequent A/B therapy depending on the results of repeated blood inoculation -

Empyreal antibiotic therapy of early sepsis must impact on gram negative and gram positive microorganisms. It's important to remember that listerias are potential agents for early infection of neonates. It is necessary to prescribe 2 antibiotics which cover a wide enough spectrum and at the same time resist a selection of antibiotic resistant bacteria. In case of late hospital sepsis it is particularly important to affect staphylococcus and gram negative bacteria.

Absence of clinical symptoms and negative results of investigation: 48-72 hr; In case of gram + flora – 7 or more days; In case of gram + flora - minimum 14 days; In case of meningitis - 21 days; Consequent a/b therapy should depend on the results of repeated blood culture

The duration of antibacterial therapy depends on clinical form of infection while therapy of osteomyelitis/endocarditis it is recommended to change antibiotics only in case of absence of

**Gestational Age (weeks.) Child Age (days) Interval between Injection (hours)** 

12 8

12 8

12 8

> 28

> 14

> 7

≥ 45 All 6

If mother discharges GBS during delivery it is advised that penicillin be prescribed.

Injected intravenously slowly during 30 minutes.


**Table 2.** Therapeutic guidelines in neonatal infection 2011 [11] Neofax 2009 Twenty Second Edition [14]

### **Dosage of Antibiotics: Amikacin**

## **AMIKACIN**

Injected intravenously slowly during 30 minutes.


**Table 3.** Therapeutic guidelines in neonatal infection 2011 [11] Neofax 2009 Twenty Second Edition [14,15]

#### **Dosage of Antibiotics: Cefotaxime**

### **CEFOTAXIME**

Single Dose 50 mg/kg intravenously slowly during 30 minutes *Or I/M*

The dosage of antibiotics is relevant to the etiological agent and depends on gestational and postnatal age of the neonate and it is chosen according to the Neofax guide.[14]

Early Detection and Prevention of Neonatal Sepsis 15

sepsis is diagnosed on the bases of clinical or microbiological data. Neonatal sepsis is an irreversible process which may cause mortality in cases of untimely detection and

You should contact your pediatrician if your baby has one of above-listed symptoms or

**Yes, the doctor will ask:** About the symptoms the baby has, previous deliveries and the baby's status at birth. Observation of child will be conducted and blood analysis of the child will be done including tests known as 'Blood Inoculation'. These tests may determine the

**Frequently, there is need to conduct further laboratory testing in order to determine the existence of infection in different parts of body. Examples of some of these** 

Lumbar Puncture (During this procedure doctor inject a thin needle into the lower part of backbone to obtain a small amount of spinal fluid. Lumbar liquid helps diagnose disease in

Most treatment is conducted in hospitals. Doctor will prescribe antibiotics (drug against

**Note:** 1 ml. is sufficient for bacterial analysis of blood if a pediatric bottle is used. All material will be used for aerobic culture therefore anaerobic organisms rarely cause early neonatal sepsis. If there is a catheter, blood is obtained simultaneously from the central and

It is desirable that diagnostic tests be repeated 24 hours after the first examination. [11]

infection) for your baby. The drug is given intravenously via a tube called an 'IV'.

Fever, though some children may have low or normal body temperature

Jaundice (baby's skin or white tunic of eyes turn a yellowish tinge)

Fingers and lips remain cyanotic (blue or purple coloration in the skin)

**Which symptoms are specific for sepsis in newborns?** 

Breathing problems or fast heart rate

Somnolence (difficulty in waking the child)

**When is it necessary to contact the doctor?** 

existence of infection in the blood.

**Is there a need to conduct laboratory tests on a child?** 

the brain and spinal cord), analysis of urine, X-ray of thorax.

**Algorithm of management for suspected neonatal sepsis** 

**What kind of treatment is conducted for newborns with sepsis?** 

treatment.

Baby feeds poorly

Vomiting

**Danger signs:** 

looks sick.

**tests may be:** 

peripheral catheter.


**Table 4.** Therapeutic guidelines in neonatal infection 2011[11] Neofax 2009 Twenty Second Edition [14]
