March 10, 2013

Neonatal Sepsis: TSB CM

Neonatal Sepsis
*Special thanks to my Pediatric MO for sharing this mnemonic. This mnemonic is about the signs of sepsis in neonate patient.

 Neonate: Pediatric age group of less than 1 month

Definition of neonatal sepsis

Clinically ill neonate with positive cultures. In some places, it is very difficult to do the blood C&S due to technical aspect. Therefore, it is very useful to treat them based on clinical judgment because untreated sepsis is devastating and deathful.

Early onset sepsis is acquired before or during delivery while late onset sepsis is acquired after delivery in the community or nursery. Nosocomial sepsis occurs after 72 HOURS of hospital stay.

SIGNS of Sepsis in Neonate

T: temperature instability defined as < 36  or  > 37

S: skin changes like pustules, cellulitis, septic spot (not specific), omphalitis, petichiae, thrombophlebitis, mottled skin, poor skin turgor.

B: blood parameter like leukocytosis or leucopenia, thrombocytosis or thrombocytopenia, blood C & S, C-Reactive Protein and ESR (not the best option for neonate as it require more amount of blood-unless have the specific tube), DIVC

** Depends on the center but in my place, we take TWBC count 5-25. Why the count in neonate patient is higher than adult? Because the presence of nucleated RBC in blood can be mistakenly interprets by the machine as TWBC. Significant point if immature to total white cell ration or I:T ratio >0.2

** is thrombocytopenia really indicates of sepsis? First, rule out platelet clumping due to poor blood taking technique and need to exclude other causes as well like congenital disease associated with thrombocytopenia.

C: Cardiovascular and respiratory including hypotension, poor perfusion, tachycardia, tachypnoeic, grunting, cyanosis, increase oxygen requirement, recurrent/prolong apnoea.

M: Metabolic: Metabolic acidosis, hypoglycemia, hyperglycemia

OTHERS are based on organ or system involvement or any multiple organ involvement.

Gastrointestinal: vomiting, distended abdomen, altered bowel habit, hepatomegaly, spleenomegaly, jaundice

CNS: irritable cry, lethargy, seizures, bulging fontanels, hypotonia

Eye: any discharge

Nose: runny nose

Musculoskeletal: septic arthritis, osteomyelitis, pseudoparesis.            

Risk of Sepsis

1) Prolong Rupture of membrane > 24 hours.
2) Maternal chorioamnionitis based on obstetrician criteria or foul smelling liquor

3) Maternal UTI
- UFEME with WBC > 10 per hpf or
- UFEME showing bacteriuria > 3+ or
- Significant positive cultures     

4) Maternal fever
- Fever >38 degree Celsius
- All episodes of Intrapartum fever

Antibiotic Therapy in our Tawau Hospital Protocol

1) Premature baby with one or more risk of sepsis
2) Term baby with two or more points

a) Prolong rupture of membrane < 24 hours (1 point)
b) Maternal chorioamnionitis (2 points)
c) Maternal UTI (1 point)
d) Maternal fever (1 point)

Or 1 point plus any one of these
a) TWBC < 5000/L or  > 25000/L
b) CRP >1.0 ng/dL
c) I:T ratio > 0.2


  1. In HSelayang, we cover for neonatal sepsis if PROM >18H

  2. its depends from center to center..some of clinician even take LL>12 h as risk of sepsis.. the reason behind that is, after 12 hours, the risk of infection is higher.. but how high is high can not be quantified.. so just follow the local center guideline.. so u're doing HO'ship in selayang now?

  3. ini mesti ilmu Dr Farhan kan..guideline ni ada kat paeds protocol gk TSB CM...jgn ET Level dah le naim

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