BOOK-BASED PATHOPHYSIOLOGY Schematic Diagram (Flow Chart) - Pathophysiology-Symptoms-Lab tests-Treatment Synthesis of the Disease Neonatal sepsis may be categorized

as early or late onset. Eighty-five percent of newborns with earlyonset infection present within 24 hours, 5% present at 24-48 hours, and a smaller percentage of patients present between 48 hours and 6 days of life. Onset is most rapid in premature neonates. Early-onset sepsis syndrome is associated with acquisition of microorganisms from the mother. Transplacental infection or an ascending infection from the cervix may be caused by organisms that colonize in the mother's genitourinary tract, with acquisition of the microbe by passage through a colonized birth canal at delivery. The microorganisms most commonly associated with early-onset infection include group B Streptococcus (GBS), Escherichia coli, Haemophilus influenzae, and Listeria monocytogenes. Late-onset sepsis syndrome occurs at 7-90 days of life and is acquired from thecaregiving environment. Organisms that have been implicated in causing late-onset sepsissyndrome include coagulase-negative staphylococci, Staphylococcus aureus, E coli, Klebsiella, Pseudomonas, Enterobacter, Candida, GBS, Serratia, Acinetobacter, and anaerobes. Theinfant's skin, respiratory tract, conjunctivae, gastrointestinal tract, and umbilicus may become colonized from the environment, leading to the possibility of late-onset sepsis from invasive microorganisms. Vectors for such colonization may include vascular or urinary catheters, other indwelling lines, or contact from caregivers with bacterial colonization. Risk Factors The most common risk factors associated with early-onset neonatal sepsis include maternal GBS colonization (especially if untreated during labor), premature rupture of membranes (PROM), preterm rupture of membranes, prolonged rupture of membranes, prematurity, maternal urinary tract infection, and chorioamnionitis. Risk factors also associated with early-onset neonatal sepsis include low Apgar score (<6at 1 or 5 min), maternal fever greater than 38C, maternal urinary tract infection, poor prenatal care, poor maternal nutrition, low socioeconomic status, recurrent abortion, maternal substanceabuse, low birth weight, difficult delivery, birth asphyxia, meconium staining, and congenitalanomalies. Risk factors implicated in neonatal sepsis reflect the stress and illness of the fetus at delivery, as well as the hazardous uterine environment surrounding the fetus before delivery. Late onset sepsis is associated with the following risk factors: prematurity, central venouscatheterization (duration of >10 d), nasal cannula continuous positive airway pressure use, H2 blocker/proton pump inhibitor use, and gastrointestinal tract pathology. Race

- Black infants have an increased incidence of GBS disease and late-onset sepsis. This is observed even after controlling for risk factors of low birth weight and decreased maternal age. Sex - The incidence of bacterial sepsis and meningitis, especially for gram-negative enteric bacilli, is higher in males than in females. Age - Premature infants have an increased incidence of sepsis. The incidence of sepsis is significantly higher in infants with very low birth weight (<1000 g), at 26 per 1000 live births ,than in infants with a birth weight of 1000-2000 g, at 8-9 per 1000 live births. The risk for death or meningitis from sepsis is higher in infants with low birth weight than in full-term neonates. Signs and Symptoms The clinical signs of neonatal sepsis are nonspecific and are associated with characteristics of the causative organism and the body's response to the invasion. These nonspecific clinical signs of early sepsis syndrome are also associated with other neonatal diseases, such as respiratory distress syndrome(RDS), metabolic disorders, intracranial hemorrhage, and a traumatic delivery .Given the nonspecific nature of these signs, providing treatment for suspected neonatal sepsis while excluding other disease processes is prudent. Cardiac signs : In overwhelming sepsis, an initial early phase characterized by pulmonary hypertension, decreased cardiac output, and hypoxemia may occur. These cardiopulmonary disturbances may be due to the activity of granulocyte-derived biochemical mediators, such as hydroxyl radicals and thromboxane B2, an arachidonicacid metabolite. These biochemical agents have vasoconstrictive actions that result in pulmonary hypertension when released in pulmonary tissue. A toxin derived from the polysaccharide capsule of type III Streptococcus has also been shown to cause pulmonaryhypertension. The early phase of pulmonary hypertension is followed by further progressive decreases in cardiac output with bradycardia and systemic hypotension. The infant manifests overt shock with pallor, poor capillary perfusion, and edema. These late signs of shock are indicative of severe compromise and are highly associated withmortality. Metabolic signs

: Hypoglycemia, hyperglycemia, metabolic acidosis, and jaundice all aremetabolic signs that commonly accompany neonatal sepsis syndrome. The infant has anincreased glucose requirement because of sepsis. The infant may also have impairednutrition from a diminished energy intake. Metabolic acidosis is due to a conversion toanaerobic metabolism with the production of lactic acid. When infants are hypothermicor they are not kept in a neutral thermal environment, efforts to regulate bodytemperature can cause metabolic acidosis. Jaundice occurs in response to decreasedhepatic glucuronidation caused by both hepatic dysfunction and increased erythrocytedestruction. Neurologic signs : Meningitis is the common manifestation of infection of the CNS. It is primarily associated with GBS (36%), E coli (31%), and Listeria species (5-10%)infections, although other organisms such as S pneumoniae, S aureus, Staphylococcusepidermis, H influenzae , and species of Pseudomonas,

CLIENT- BASED PATHOPHYSIOLOGY Schematic Diagram (Flow Chart) - Pathophysiology -Symptoms-Lab tests-Treatment Synthesis of the Disease As for Baby Boy S, he had an early-onset neonatal sepsis. A type of sepsis acquired from the mother and/or before delivery. Early-onset neonatal sepsis most often appears within 24 hours of birth. Risk Factors of Baby Boy S includes

Male- it is said that neonatal sepsis is common to male infants than female.

Maternal UTI- baby boy Ss mother had UTI during the second trimester Signs and Symptoms The patient experienced:

Continuous vomiting during the first 24 hours of lifeClinical Signs includes:

Increased WBC count of 25.8 g/LResults in 09-09-09 Normal value of 4.3-10.0 g/L

Increased hematocrit count of 63.0Results in 09-09-09 Normal value of 40.0-54.0 for males VI.THE PATIENT AND HIS CARE1.Medical Management A. IVF IVFDate OrderedDatePerformedGeneralDescriptionIndicationsClientsResponse D 10 W 500ccx 8 ugtts/minSept. 9, 200912:15 a.m.This medication is asolution given byvein (through anIV). It is used tosupply water andcalories to the body.It is also used as amixing solution(diluent) for other IV medications.Dextrose is a naturalsugar found in the body and serves as aIV solutionscontainingdextrose areindicated for parenteralreplenishment of fluid andminimalcarbohydratecalories asrequired by theclinical conditionof the patient. Itthe client adheredwell and did notmanifest for anyside effects major energysource. When usedas an energy source,dextrose allows the body to preserve itsmuscle mass.is also use as amixing solutionfor other IVmedication.