I Injury * Accidental Infection *Sudden infant death Syndrome *Sever pneumonia *Deliberate Congental Anomaly *Sepsis * Subendocardiac *Gasteroenteritis *Fibroelastosis *Long QT Syndrome *Cardiac Anomaly *Pulmonary Anomaly

*Neurological Anomaly

FT baby 6days old, producte of home vaginal delivary with PROM>24hr ,he had fever&vomting,poor sucking laste 3days.O/E ;Lethargic,febrile(38C) NN reflex weak

Pathways of ascending or intrapartum infection

Pathogenesis of hematogenous transplacental infections

It is the systemic inflammtory responesto an infection process.

The most commen cause;

GBS , E-Coli ,L-monocytogenusOther causes are ;(non-bactrial)Viral , protozal , fungal

TRANSPLACENTALPERINATALPOSTNATAL

CMVAnerobic bacteria

Adenvirus

HSVChlamydiaCandida spp.

Mycobacterium Tunerculosis

Enteric BacteriaCoagulase Neg. Staphyloccoci

Rubella virusGBSCMV

T. PallifdumH. influenzaeEchovirus

VZVHSVEnteric bacteria

L. monocytogenes

Influenza virus ,A, B

MycoplasmaParainfluenza

Pseudomonas

RSV ,staphylococcus Aureus

Mycobacterium Tuberculosis

Etiologic Agents of Neonatal Pneumonia According to Timing of Acquisition

BACTERIAEARLY ONSETLATE ONSET, MATERNAL ORIGIN

LATE ONSET, NOSOCOMIAL

LATE ONSET, COMMUNITYGRAM POSITIVE

Clostridia+ +

Enterococci+ ++ Group B streptococcus++++++Listeria monocytogenes

++  

Other streptococci++  +Staphylococcus aureus+ +++Staphylococcus, coagulase negative

+ +++ 

Streptococcus pneumoniae

+  ++

Viridans streptococcus+ ++ GRAM NEGATIVE

Bacteroides+ + Campylobacter+   Citrobacter  ++Enterobacter  + Escherichia coli+++ +++Haemophilus influenzae+  +Klebsiella  + Neisseria gonorrhoeae+   Neisseria meningitidis+ + Proteus  + Pseudomonas  + Salmonella + +Serratia  + 

OTHERS

Treponema pallidum++  Mycobacterium tuberculosis

 +  

Maternal

Intrapartum fever(>38)PRM(>18hr)ChorioaminionitsPT labor(<37wk)

NeonatalMale sexPT& LBWCong—anomaliesImmunity defectGalactosemia(E-Coli)

General;Fever.temperature instabilityPoor feedingGIT;

Diarreh,VomitingAbd-distentionRespiratory;Apnea,RDSRenal;oliguria

CNS;Irritability,lethargy,seizers High pitch cry,hypotonia,Full fontanel,CVS;

Pallor,mottling,HR) (hypotention,Hematology; Jaundies, pallor,petechia,purpuraBleeding

sepsis workup;

*Culture; Blood—CSF—Urine*CBC; WBC(<5000), ANC<1750, I : T>0,2

*CRP*G.stain;CSF,Urine;Infected side

*Chest Xry

Once the pathogen has been identified & antibiotic sensitivities determined, the most appropriate drug or drugs should be selected.

For most gram-negative enteric bacteria, Ampicillin & an Aminoglycoside or a 3rd-generation cephalosporin (cefotaxime or ceftazidime) should be used .

Enterococci should be treated with both a penicillin (Ampicillin or piperacillin) & an aminoglycoside because the synergy of both drugs is needed. Ampicillin alone is adequate for L. monocytogenes,

and penicillin suffices for GBS .

Clindamycin or metronidazole is appropriate for anaerobic infections

Is determined by pattern of disease and the organisms that are common for the age of

infant&

the flora of the nursery.

Duration of Rx;

meningits(14—21days)Pneumonia(7—10)

CVS;

CHD.myocaditis,PPHNGIT;

Necrotizing enterocolitisspontanousGITperfora-tionHematology;

Nnpurpuric fulminansSever anemiaImmune mediated neutropenia&thromboc-ytopenia

Respiratory;

RDS,lung hypoplasiaTEOF,aspiratin pneumonia,

Metabolic;

HypoglysemiaGalactosemiaCNS;

HIE.Infant botulismICH

The risk factors for death or for moderate or severdisability include;

*Duration of seizeres >72hrs*Coma

*Necessity for the use of inotropic agents*Lukopenia

MANIFESTATIONPATHOGEN

Intrauterine Growth Restriction

CMV, Plasmodium, rubella, toxoplasmosis, Treponema pallidum, Trypanosoma cruzi, VZV

Congenital Anatomic Defects

CataractsRubella

Heart defectsRubella

HydrocephalusHSV, lymphocytic choriomeningitis virus, rubella, toxoplasmosis

Intracranial calcificationCMV, HIV, toxoplasmosis, T. cruzi

Limb hypoplasiaVZV

MicrocephalyCMV, HSV, rubella, toxoplasmosis

MicrophthalmosCMV, rubella, toxoplasmosis

Neonatal Organ InvolvementAnemiaCMV, parvovirus, Plasmodium, rubella, toxoplasmosis, T. cruzi, T.

pallidumCarditisCoxsackieviruses, rubella, T. cruzi

EncephalitisCMV, enteroviruses, HSV, rubella, toxoplasmosis, T. cruzi, T. pallidum

HepatitisCMV, enteroviruses, HSV

HepatosplenomegalyCMV, enteroviruses, HIV, HSV, Plasmodium, rubella, T. cruzi, T. pallidum

HydropsParvovirus, T. pallidum, toxoplasmosis

LymphadenopathyCMV, HIV, rubella, toxoplasmosis, T. pallidum

OsteitisRubella, T. pallidum

Petechiae, purpuraCMV, enteroviruses, rubella, T. cruzi

PneumonitisCMV, enteroviruses, HSV, measles, rubella, toxoplasmosis, T. pallidum, VZV

RetinitisCMV, HSV, lymphocytic choriomeningitis virus, rubella, toxoplasmosis, T. pallidum, West Nile virus

RhinitisEnteroviruses, T. pallidum

Skin lesionsEntroviruses, HSV, measles, rubella, T. pallidum, VZV

ThrombocytopeniaCMV, enteroviruses, HIV, HSV, rubella, toxoplasmosis, T. pallidum

Clinical Manifestations of Transplacental Infections

Aggressive management of suspected maternal chorioamnionitis with antibiotic therapy during labor,along with rapid delivaryof the infant,reduces the risk of early Nnsepsis.

Intrapartum chemoprophylaxsis reduced the vertical transmission of GBS .

That is unexpected by history and unexplained by a thorough postmortem examination ,which includes a complete autopsy,investigation of the scene of death, and review of medical history .

Maternal;

Smoking,DrugsNutritional deficiencyDecreased age,educationSingle marital statusIGR,increas parityLow socioeconomic status

Infant;Age(2-4mo),PT,MalePron sleep positionGrowth failureRecent(febrile) illnessSoft bedding

Objectives ;

*Definition Factors ;

Risk * Mternal &neonatal

* Types & clinical manifestation l

Diagnosis *

Treatment *Prognosis *

Prevention * * DD