Infection risk

CHAPTER 17 Infection risk



David Cartwright, Mark Davies, Garry Inglis



Infection risk and signs


All babies born after labour or ruptured membranes, either vaginally or by caesarean section, should be regarded as potentially infected — regardless of your supposed knowledge of maternal colonisation status.


Risks of infection increase with:


• prolonged rupture of membranes, especially ≥18 hours

• multiple vaginal examinations

• known colonisation with pathogenic organisms, e.g. group B Streptococcus (GBS)

• a previously affected infant with early-onset septicaemia.

Signs of infection before delivery may include:


• maternal fever ≥38°C

• maternal tachycardia

• fetal tachycardia

• premature rupture of membranes

• preterm labour.

Signs of infection after birth may include:


• unexpected need for resuscitation

• early onset of apnoea

• fever

• poor peripheral perfusion

• respiratory distress.

Haematological evidence of infection includes:


• neutropaenia

• a left shift — immature : total (IT) neutrophil ratio ≥0.2

• toxic changes seen in neutrophils (toxic granulations, vacuolation, Dohle bodies, intracellular bacteria).


Antibiotic use


There is no magic formula that tells us which babies must be treated with antibiotics.


• If a baby is infected, early treatment is essential. This means treating all babies with reasonable risks, as above, with antibiotics for 36–48 hours until the blood culture is negative (with no haematological evidence of infection) and the baby is known to be well.

• Treat all babies with respiratory distress with antibiotics — the only possible exception is those babies born by ‘cold’ elective Caesarean section or a Caesarean section for pre-eclampsia or intrauterine growth restriction.

• Treat all babies whose mother has had fever ≥38°C with antibiotics.

• Treat all babies born after preterm labour with antibiotics, unless they are completely well and there are no other risk factors.


Antibiotics should be given within half an hour of a decision to start them.


Always take a blood culture before commencing antibiotics.


Arrange a full blood count (FBC) and film examination for the next convenient blood collection time.

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Related posts:

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  2. Care of the extremely preterm baby
  3. Maternal thyroid disease
  4. Withdrawal of treatment

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Jul 18, 2016 | Posted by in PEDIATRICS | Comments Off on Infection risk

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