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Common Blood Diseases in Newborns

- Neonatal Sepsis

Neonatal sepsis is the presence of pathogenic microbes and their toxins in the bloodstream. It is a serious condition that can be life-threatening, especially in preterm infants admitted to the neonatal intensive care unit (NICU), due to multiple invasive procedures and inadequate infection control practices.

Risk Factors:

Maternal Factors:

  • Maternal fever during pregnancy.
  • Preterm birth.
  • Prolonged rupture of membranes (≥ 18 hours before delivery).
  • Maternal urinary tract infections during pregnancy.

Neonatal Factors:

  • Immature immune system, especially in preterm infants.
  • Invasive procedures such as intubation, cannulation, or central catheter insertion.
  • Formula feeding.

Hospital-Related Factors:

  • Poor infection control practices, particularly inadequate hand hygiene.
  • Overcrowding and understaffing in the NICU.
  • Insufficient handwashing facilities.
  • Presence of asymptomatic carrier newborns.

Nurse’s Assessment:

Medical History:

  • Gestational age.
  • Maternal infections during pregnancy (e.g., Group B Streptococcus infection).
  • Prolonged rupture of membranes.
  • Low Apgar score.
  • History of neonatal sepsis in a previous sibling.

Newborn Examination:

Sepsis presents with varied symptoms requiring a comprehensive examination:

  • General lethargy and reduced activity.
  • Weak sucking reflex and poor feeding.
  • Gastrointestinal symptoms such as vomiting, feeding intolerance, abdominal distension, or diarrhea.
  • Temperature instability (hypothermia or hyperthermia).
  • Respiratory distress signs (e.g., tachypnea, apnea, increased respiratory secretions).
  • Umbilical stump infection signs (e.g., purulent discharge, foul odor).
  • Hypoglycemia symptoms.

Critical Symptoms Requiring Immediate Medical Attention:

  • Hypotension.
  • Severe abdominal distension.
  • Seizures.
  • Signs of neonatal shock.

Laboratory Tests:

  • Complete blood count (CBC).
  • C-reactive protein (CRP).
  • Blood culture.
  • Urine culture.
  • Cerebrospinal fluid analysis and culture.
  • If respiratory distress is present:
    • Chest X-ray.
    • Blood gas analysis.
    • Sputum culture.

Nursing Care:

Infection Control Measures:

  • Maintaining NICU hygiene.
  • Wearing hospital scrubs in the NICU and following proper handwashing protocols.
  • Ensuring an adequate nurse-to-patient ratio for optimal care.
  • Adhering to infection control practices during preparation of intravenous fluids, medication administration, blood sampling, and catheter insertion.
  • Cleaning and disinfecting equipment such as incubators and ventilators before use on another infant.
  • Assigning dedicated tools (e.g., stethoscope, thermometer) for each infant.
  • Using protective equipment (e.g., masks, gowns, gloves) when handling infected infants.
  • Reducing waterborne infections by:
    • Using sterile water in nebulizers and humidifiers.
    • Regularly draining condensation from ventilator circuits.

Care for an Infected Newborn:

  • Continuous cardiac and respiratory monitoring until stabilization.
  • Checking vital signs hourly until stabilization.
  • Monitoring blood glucose levels as per medical instructions.
  • Observing respiratory distress symptoms and suctioning secretions if needed.
  • Providing oxygen therapy or mechanical ventilation as required.
  • Monitoring for seizures and reporting any occurrences.
  • Following the doctor’s instructions regarding feeding and intravenous fluids.
  • Maintaining fluid balance records.
  • Measuring abdominal circumference in cases of feeding intolerance or abdominal distension.
  • Administering antibiotics as prescribed.