INTRODUCTIONNewborn infants are at much higher risk for developing sepsis than children and adults because of their immature immune systemespecially premature infants, where 1 out of every 250 will be diagnosed with sepsis. Sepsis is one of the major leading causes of death in the first few months of a newborns life. Infections can contribute up to 13-15% of all deaths during the neonatal period with the mortality rate reaching as high as 50% for infants who are not treated timely.Infections are a major contributor to newborn deaths in developing countries. Majority of these deaths occur at home without coming to medical attention. The Millennium Development Goal for child survival cannot be achieved without substantial reductions in infection-specific neonatal mortality. We describe the burden of neonatal infections in developing countries and discuss the need for community-based management approaches to improve survival from neonatal infections in these countries.DEFINITIONNeonatatal infection is the infections that occurred soon after birth due to some maternal infections or bacterias colonised from insturuments.INCIDENCESThe incidence of serious acute infections in neonates is around 2/1,000 live births but the figure rises to 8-9/1,000 in small babies weighing just 1,000 to 2,000 grams and 26/1,000 in those of less than 1,000 grams. GBS is the most frequent cause of severe early-onset neonatal infection in neonates and occurs in 0.5/1,000 UK births.Of early-onset neonatal sepsis, 85% presents in the first 24 hours, 5% between 24 and 48 hours, and the remaining 10% over the subsequent 4 days. Early-onset infections include GBS, Escherichia. coli, Haemophilusinfluenzae, and Listeria monocytogenes and are most likely to have been acquired transplacentally, by ascending or intrapartum infection.RISK FACTORS OF NEONATAL INFECTION Rupture Maternal intra part of fever Low birth weight infant Chorioamniontis Mother with beta haemolytic streptococccal infection Repeated vagina examination in labour

MODES OF INFECTIONAntenatala) Transplacental : Maternal infection that can affect through placental root. They are rubella,cytomegalovirus,herpesvirus,HIV,chickenpox and hep B. other infections are syphilis,toxomoplasmosis and tbb) Amnionits: aminonitis following premature rapture of membrane can be affected the baby following aspiration or injection of infected amniotic fluid.IntranatalThe following are the modes of intranatal to the babiesa) Aspiration of infected liqor or meconium following early rupture of membrane or repeated internal examination this may lead to neonanatalsepsis.b) While the fetus is passing through the infected vaginac) Improper asepsis while caring the umblicalcord.PostnatalTransmission due to human contact :a) infected mother relatives or staffs of the nurseryb) Cross infection from a infected baby in the nursery.c) Infection through feeding, bathing, clothing or airborneCOMMON SITES OF INFECTIONTrivial but may not be serious Eyes-ophthalmia neonatorum Skin infections Umbilicus sepsis (omphalitis) Oral thrushSevere systemic Respiratory tract Septicaemia Meningitis Intra abdominal infection

OPHTHALMIA NEONATORUMDEFINITION Ophthalmia neonatorum is defined as inflammation of the conjunctivitis during first month of lifeCAUSES The cause of the conjunctivitis may be an irritation in the eye or a blocked tear duct. In some cases the irritation may be from the antibiotic given after delivery. The common causative organism are Chlamydia trachomatis,other bacterial causes like gonococcus,styphylococcus chemicals like silver nitrate viral:herpes simplexMODE OF INFECTIONInfection occurs mostly during delivery by contaminated vaginal discharge. It is more likely in face or breech delivery. During neonatal period, there may be direct contamination from other sites of infection or by chemical.CLINICAL FEATURES The most common symptoms are redness and swelling of the conjunctiva in the newborn. Drainage and discharge from the eye; it may be watery or thick and pus-like Swollen eyelids Cornea may be involved in severe cases.DIAGNOSIS If your babys pediatrician suspects ophthalmianeonatorum, an eye examination will be done. The doctor will look at your babys eyes to check for anything that may be irritating the eye, and to see if any damage has occurred. The doctor may also want to take a sample / smear of any discharge to determine what type of bacteria or virus is causing the infection. Culture and sensitivity Scraping material from kwier conjunctiva for Giemsa staining and also culture in suspected ehlamydial infection; Culture in special viral media for suspected herpes simplex infection.

PROGNOSISIt is favorable to most cases except in neglected cases with rare gonococcal infection. Fortunately, effective methods of prophylaxis and treatment have almost eliminated the risk of blindness.PREVENTIONAny suspicious vaginal discharge during the antenatal period should be treated and the most meticulous obstetric asepsis is maintained at birth. The newborn baby's closed lids should be thoroughly cleansed and dried.TREATMENT Prophylaxis: 1 percent silver nitrate solution (1-2 drops to each eye), 0.5 percent erythromycin ophthalmic ointment, 25 percent povidone iodine solution (1 drop each eye) is administered within 1 hour of birth and is continued for few days.The treatment of ophthalmianeonatorum depends on the cause:1) Blocked Tear Duct In cases of ophthalmianeonatorum that are due to a blocked tear duct, the doctor may recommend warm compresses and gentle massage to the area to help unclog the duct.2) Irritation Ophthalmianeonatorum due to irritation usually improves on its own in a few days. In some cases, the irritation may be from the antibiotic given after delivery. Silver nitrate, which was often used in the past to prevent eye infection, can cause irritation in the babys eye. Many hospitals now use other types of antibiotics to avoid this irritation.3) Bacteria Infants that have an eye infection due to bacteria are given antibiotics.Antibiotic ointment will be started right away.Antibiotics are also given orally or as an injection if caused by an STD.Drugs used in infections area) GonococcalInfant is isolated during the first 24 hours of treatment. Eyes are irrigated with sterile isotonic saline every 1-2 hours until clear. In severe and culture positive cases systemic ceftriaxone 50 mg/kg or cefotaxime 50 mg/kg/q 12 h is given IM/IV. Single dose in infant without dissemination or for 7 days when there is dissemination, is usually given.b) ChlamydiaErythromycin suspension 40 mg/kg daily orally divided into 4 doses for 14 days is given to prevent systemic infection. Topical treatment alone is ineffective.c) Herpes simplexThe infant is isolated. Systemic therapy with acyclovir 20 mg/kg every 8 hours for 2 weeks is given IV. Topical use of 0.1% iododeoxyuridine ointment 5 times a day for 10 days is used.

SKIN INFECTIONSkin infection is predominantly due to staphylococcus aureus. Unhygienic environment, cross infection or carriers are the source of infectionIN MILD FORMSuperficial pustules, single ore scattered are the formed on the face axilla or scalpPemphigus neonatorum: it is the serious form of skin infection in the new born .it may become epidemic and may cause septic caemia . superficial blisters appear on the part of skin become pustules and then burst.CURATIVEThe baby is place in isolation the blisters are pricked by sterile needle and after removal of dead skin the area is to be smeared with antibiotic ointment(1% gentianviolet in spirit).Systematic administration of erythromycin 25 mg per kg or cloxacillin 50 mg per kg per day in 3 to 5 divided doses.PREVENTIONBaby bath is best avoided in hospital delivery the infected babies are to be kept in separated nursery. The carriers or sources of infection are to be sought for an appropriate measures to be taken.UMBILICAL SEPSIS (OMPHALITIS)DEFINITIONOmphalitis is the medical term for infection of the umbilical cord stump in the neonatal newborn period. The causative organisms are staphylococcus, e coli or pyogenic organism.SIGNS AND SYMPTOMS infection (cellulitis) around the umbilical stump (redness, warmth, swelling, pain) pus from the umbilical stump, fever fast heart rate (tachycardia)Omphalitis can quickly progress to sepsis and presents a potentially life-threatening infection.SPREAD OF INFECTION 1. Periumbilical cellulitis with suppuration; 2. Thrombophlebitis of the umbilical vein with extension of the infection to the liver producing hepatitis or pyemic liver abscess; 3. Peritonitis; 4. Necrotizing fascitis.DIAGNOSISDiagnosis is usually made by the clinical appearance of the umbilical cord stump and the findings on history and physical examination. There may be some confusion, however, if a well-appearing neonate simply has some redness around the umbilical stump. In fact, a mild degree is common, as is some bleeding at the stump site with detachment of the umbilical cord. If needed culture and sensitivity test is done.PREVENTIONAntiseptic and aseptic precaution should be taken right from the time of cutting the cord to the time of complete epithelization of the area after falling of the cord. TREATMENT Complete septic work up (CBC, blood and umbilical swab culture) is done. Antibiotic therapy with nafcillin and gentamicin or oxacillin or piperacillin/tazobactum may be used depending upon the severity of infection. The wound is dressed like any surgical wound with spirit and antiseptic powder.TETANUS NEONATORUM:It is rare nowadays but may cause concern in the tropical countries. The infection is caused by Cl. tetani and the portal of entry is through the umbilical cord. The features are evident within 5-15 days after birth.

THE STRIKING FEATURES Inability to suck associated with marked trismus followed by rigidity of the body with opisthotonus, pyrexia convulsions.PREVENTIONIncludes immunization of the mother during pregnancy with tetanus toxoid. Babies born in unhygienic conditions without previous immunization of the mother, should be given 1500 1U of antitetanus serum intramuscularly soon after birth.CURATIVE TREATMENT The baby should be isolated in the Infectious Disease Hospital; Tetanus immune globulin (human) 6000 IC is given intramuscularly Anti tetanus serum (ATS) should be started immediately in doses of 50,000-100,000 units intramuscularly or intravenously. The same dose may have to be repeated after 12 hours; Antibiotics' 1.-,art-cularly penicillin should be given in heavy doses; Sedation should be ensured by intramuscular administration of either (a) Chlorpromazine 5-10 mg/kg per day or (b) Phenobarbitone 15 mg/kg per day in divided doses. Both may be combined so as to be more effective; Endotracheal intubation and ventilation may be needed; Nutrition is to be maintained by intragastric feeding. Prognosis: Mortality is up to 60-80%.NECROTIZING ENTER COLITISNecrotizing enterocolitis (NEC) is a medical condition primarily seen in premature infants, where portions of the bowel undergo necrosis (tissue death). It is the second most common cause of morbidity in premature infants and requires intensive care over an extended period.CAUSES Premature infants Perinatal asphysis Polycythemia Umbilical cord catheter related thrombo embolism Septecimia due to ecoli,klebcsiella

RISK FACTORS Premature infants Perinatal asphyxia Hypotension Polycythemia U.mbilical cord catheter related thromboembolism; Septicemia due to E coil, Klebsiella, Pseudomonas Exchange transfusion.PATHOPHYSIOLOGYThere is ischemic and/or toxic damage to the mucous membrane of the gut commonly in the ileocecal region. It is associated with bacterial proliferation and gas formation. Gradually there is ischemic necrosis of the muscular wall of the gut, ultimately leading to perforation and peritonitis.SIGNS AND SYMPTOMSThe condition is typically seen in premature infants, and the timing of its onset is generally inversely proportional to the gestational age of the baby at birth, i.e. the earlier a baby is born, the later signs of NEC are typically seen. Initial symptoms include feeding intolerance, increased gastric residuals, abdominal distension and bloody stools. Symptoms may progress rapidly to abdominal discoloration with intestinal perforation and peritonitis and systemic hypotension requiring intensive medical support.clinical features are divided into 3 stages:Stage 1 Apnea, bradycardia, lethargy, abdominal distension and vomiting.Stage 2 Pneumatosisintestinalis and the above features.Stage 3 Low blood pressure, bradycardia, acidosis, disseminated intravascular coagulation (DIC) and anuria.Systemic signs: Respiratory distress, lethargy, feeding intolerance, hypertension, acidosis, oliguria and bleeding diathesis. Abdominal signs are: Abdominal distension, tenderness, bloody stools, vomiting.DIAGNOSISThe diagnosis is usually suspected clinically but often requires the aid of diagnostic imaging modalities. Radiographic signs of NEC include dilated bowel loops, paucity of gas, a "fixed loop" (unaltered gas-filled loop of bowel), pneumatosisintestinalis, portal venous gas, and pneumoperitoneum (extraluminal or "free air" outside the bowel within the abdomen). The pathognomonic finding on plain films is pneumatosisintestinalis. More recently ultrasonography has proven to be useful as it may detect signs and complications of NEC before they are evident on radiographs. Diagnosis is ultimately made in 510% of very low-birth-weight infants (