• early onset sepsis
  • Group B streptococci (#1)
  • E coli 
• late onset sepsis
  • coagulase negative Staph (S. epidermis)
  • S. aureus
  • GBS
  • E coli

• CMV
• HSV
• rubella
• parvovirus
• HIV

• early onset
• late onset

• usually within first week of life
• involves complications in pregnancy
• source of organism- maternal
• course- rapidly progressing
• clinical presentation (fulminant multisystem)
  • respiratory distress, pulmonary infiltrates, pneumonia
  • hepatosplenomegaly

• within first six weeks of life
• nosocomial infection in the nursery or new born ICU and/or CNS infection (focal meningitis)
• slowly progressive
• could have or could not have complications in pregnancy
• could cause complications in pregnancy

• Enterobacter
• Klebsiella
• Pseudomonas
• Serratia

• Candida albicans
• C. parapsilosis

• early onset: rapidly fatal irreversible shock w/ pneumonitis, hepatic, renal, adrenal necrosis
• late onset: meningitis and vasculitis

• perinatal
  • ascending intravaginal infection (MOST COMMON)
  • blood borne infection through placenta (rare for bacteria)
• postnatal- nosocomial (IV catheters)

• preterm delivery (maternal IgG doesnt get transported until 32 wks gestation)
• premature rupture of membranes (PROM)- more than 18 hrs predispose to infection
• maternal chorioamnionitis
• intrapartum fever

Highest risk: low birth weight infant born to a febrile mother with PROM before onset of labor

Other risks:

• AA, Hispanic
• birth weight less than 2500 grms
• infants born to women less than 20 yrs old
• maternal colonization with group B streptococcus (positive urine culture)

• seeding of blood weeks following colonization resulting from birth
• seeding of bloodstream by invasive procedures in NICU including:
  • endotracheal placement
  • umbilical vessel catheterization
  • central and percutaneous vascular devices
  • feeding tube placement
  • frequent blood sampling
• heavy use of antbiotics promote candidal overgrowth

• low circulating IgG concentration in premature infants
• low alternative complement
• impaired macrophage chemotaxis and cytokine production
• functional deficits in neutrophils

• alternation in temperature (fever OR hypothermia)- classic fever not common
• nonspecific signs- poor feeding, lethargy, irritability
• respiratory signs- tachypnea, grunting, retractions, cyanosis, nasal flaring
• hepatic signs- jaundice (hyperbilirubinemia), hepatomegaly
• GI signs- decreased feeding, weak suck, vomiting, abdominal distension
• CNS signs- in neonatal meningitis there are nonspecific signs and focal seizures (classic signs are unusual)
• cutaneous signs (pustular lesions, Staph; cellulitis, vescicles, petechiae, purpura)

• isolation of pathogen from one or more blood culture
• single blood culture with 1 mL of blood is 85% sensitive
• some organisms are slow growing organism (coagulase neg. Staph and yeast) may require more than 48 hrs of incubation
• requires lumbar puncture
• clinical judgement
• high WBC count
• marrow depletion of neutrophils
• increase CRP (useful indicator with short half life)

• early onset: ampicillin, Gentamicin
• late onset: tailor depending on nosocomial pathogens present in nursery (usually vancomycin and cephalosporins)
• therapy for 10 days for sepsis and 2 wks for meningitis
• supportive therapy- fluid and electrolytes, monitor for hyperbillirubinemia, watch for DIC and administer blood products
• adjunct therapies- granulocyte transfusions, IgIV

• maternal intrapartum antibiotic prophylaxis
• based on combination of vaginal/rectal cultures for GBS at 35-37 wks + risk factors

• most pregnant women are asymptomatic
• can only be ID by serology
  • mainly IVDA or sexual partners of abusers
• children who are untreated asymptomatic usually develop symptoms by one year of age

• huge reduction in US with increased serosurveillance
• maternal tx in anti-retrovirals reduces maternal viral load and diminishes probability of vertical transmission
  • prior to maternal therapy, infants have 30% chance of catching HIV
  • risk after therapy is less than 5%

• dx
  • newborns are asymptomatic, but if untreated, will develop repeated bacterial infections or other unique pediatric manifestations
  • ALL kids born to HIV+ mothers will have maternal Ab on board
  • Ab screening NOT useful in determining who is infected
  • dx via PCR of blood and culture
• management- follow CD4 T cells and viral load by quantitative PCR

• recurrent pneumococcal bacteremias
• lymphocytic interstitial pneumonitis (LIP) caused by EBV (tx with steroids)
• CNS: developmental delays and basal ganglia calcifications

• usually asymptomatic with occasional mononucleosis like illness
• dx established by seroconversition or +IgM for CMV
• prevention- reduced contact with multiple young children, wash hands

• symptoms
  • most asymptomatic
  • small for gestational age (intrauterine growth retardation)
  • hearing loss, mental retardation
  • periventricular calcifications may be present
  • hepatosplenomegaly
• dx- culture virus from urine or PCR shortly after birth
• tx- no tx, but potential for vaccine

• incubation in 10-20 days
• classical rash, but more severe manifestations require tx with acyclovir
• dx- virus isolation from vesicle
• prevention- VZIg in mothers who are susceptible (previously neg. Ab test) and significant exposure

• in utero infection within first 20 wks of gestation
  • skin scaring
  • muscle atrophy
  • micophthalmia
  • death
• tx- tx active disease with acyclovir
• newborn VZ Ig

• transmission
  • neonatal infection from HSV-2 that occurs as STD in mother during pregnancy (less frequent due to reactivation disease)
  • acquire during intravaginal delivery
• tx- C section if develop third trimester infection

• severe neurlogic disease
  • life long impairment requiring institutionalization
  • panencephalitis
  • seizures
  • impressive changes on head CT/MRI
• early onset in first week of life presents with sepsis like picture
• encephalitis present in week 3 of life
• often vesicular rash on skin
• tx- acyclovir (unsure if it prevents neurodevastation)

• human parovirus B19 (attacks progenitor stages of RBC's)
  • children- erythema infectiosum (fifth disease)
  • adults- arthralgias/arthritis
  • pts with decreased RBC production and chronic infection with anema (aka the immunocompromised)- transient aplastic crisis

• signs/symptoms (could be asymptomatic)
  • arthralgia
  • diffuse red rash on trunk or face (slapped cheek)
• dx- IgM specific for B19 Ab persists for 2-6 mnths
  • most women have IgG Ab indicative of immunity
• prevention- avoid contact with children who may have been exposed (only main method of prevention)
  • household transmission high

• symptoms/signs
  • in utero infection cause diminished RBC production
    • results in hydrops fetalis (anasarca)
• dx- PCR or DNA hybridization of amniotic fluid or tissue, persisting IgG Ab
• management transfusion and digoxin/ digitalis

• epidemiology- Central and South America
  • commonly vaccine kids against measles only, and not MMR
• symptoms
  • heart defects (pulmonary A. stenosis)
  • cataracts
• prevention- add R to the M in Americas

• symptoms
  • chorioretinitis
  • seizures
  • hydrocephalus
    • calcified granulomas in midbrain
    • blocked ventricular fluid flow
  • HSM
  • lymphadenopathy
  • jaundice
  • fever
• dx- IgM Ab
• tx- Pyrimethamine and Sulfa +leukovorin rescue

• high rates in Europe, esp. France (beef tartare)
• apicomplexan intracellular parasitic protozoan
• transmission to fetus with infected mother 15% of time