21.    A 5-day old infant at the NICU presents with pallor, jitteriness and feed intolerance.                              

a)        What is the likely diagnosis?

           Neonatal sepsis.

b)         What is the probable cause?

            Nosocomial infection.

c)         What are the predisposing risk factors of neonatal infections? 

            1.    Low birth weight.

             2.    Premature rupture of membranes.

             3.    Prolonged rupture of amniotic membranes.

             4.    Maternal peripartum infection.

d)         What investigations will you do?

            1.    Obtain a blood culture. 

             2.    WBC.

             3.    Chest X-ray.

e)         How would you manage this patient?

             1.    Antibiotic therapy: start with ampicillin and gentamicin.

             2.    Supportive therapy: monitor BP, treat hypotension, give CPAP if PaO2 is low, monitor platelet counts and PT/PTT, monitor and treat hypoglycaemia.

             3.    Follow-up for long-term sequelae, e.g. hearing loss, developmental delay. 

f)         What preventive measures can you take in the NICU?

            1.    Proper hand-washing before and between handling all babies.

            2.    Use of aseptic technique during insertion of intra-vascular catheters.

            3.    Proper disposal of needles and sharps.

            4.    Avoid prolonged antibiotic usage.