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Ebook A manual of neonatal intensive care (5/E): Part 2

(BQ) Part 2 book “A manual of neonatal intensive care” has contents: Neurological problems, endocrine disorders, gastroenterological problems, neonatal haematology, genitourinary problems, metabolic disorders, including glucose homeostasis and inborn errors of metabolism, and other contents. | 16 Infection Key points ■■ ■■ ■■ ■■ ■■ ■■ ■■ Meticulous hand washing and the use of alcohol gel is the best way to prevent crossinfection in a neonatal unit. Infection remains an important cause of morbidity and mortality at all birth weights and gestations, but is particularly important in very preterm babies. Perinatal infection is an important contributor to neuronal damage and adverse outcome in preterm babies, even without meningitis (‘cytokine’-mediated damage). The bacterial organisms that most commonly infect babies are group B betahaemolytic Streptococcus and Escherichia coli, with coagulase-negative staphylococci a frequent cause of late-onset sepsis in very low birth weight babies. Any baby suspected of sepsis must have investigations, including a blood culture, carried out immediately, and antibiotics (usually penicillin and an aminoglycoside) started straight away. Although herpes infection is rare, it is important to think of the diagnosis and start intravenous aciclovir; one clue is the absence of bacterial organisms on a gram stain of cerebrospinal fluid (CSF) when the CSF also contains a high number of white cells in a baby who has not been previously treated with antibiotics. Neonatal bacterial meningitis has a high risk of adverse outcome. All cases should be managed in large centres with appropriate expertise. ■■ Infection control in neonatal units Babies usually emerge from a sterile intra-uterine environment, and it follows from this that most infections in babies admitted to neonatal units (NNUs) are hospitalacquired, or nosocomial, infections. The risk of nosocomial infection is directly proportional to the number and crowding of babies in the unit, the number of infections in those babies, and the number of people (visitors and staff) going in and out of the unit. Staff who are overworked have less time for hand washing. NNUs should be spacious and designed so that only those who need to enter them pass through, and with plenty of .