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92 - Neonatal Infection

from Part XI - The Susceptible Host

Published online by Cambridge University Press:  05 March 2013

Patrick G. Gallagher
Affiliation:
Yale University School of Medicine
Robert S. Baltimore
Affiliation:
Yale University School of Medicine
David Schlossberg
Affiliation:
Temple University School of Medicine, Philadelphia
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Summary

BACTERIAL INFECTIONS

Epidemiology

Neonatal infections are usually classified according to time and mode of onset in 3 categories: (1) prenatal, (2) perinatal, (early onset), and (3) nursery-acquired (late onset). The division in time between early and late onset is usually 2 to 5 days of age (Table 92.1). Infections that begin within the first month of life are considered neonatal, but many intensive care units for neonates provide continuing care for infants several months of age with complex problems that are the result of prematurity and complications of neonatal disorders. Therefore, neonatal nursery-associated infections may occur in infants up to a year of age. Bacterial infections due to rapidly dividing high-grade pathogens that set in substantially before birth usually result in a stillbirth. Generally it is not possible to distinguish infections acquired shortly prior to birth from those acquired as a result of contact with maternal vaginal, fecal, or skin flora during delivery.

Neonatal sepsis occurs in approximately 2 to 4 per 1000 live births in the United States. Worldwide reports vary from 1 to 10/1000 live births. Risk factors noted in Table 92.1 have a very strong predictive influence on infection rates. Full-term infants born without incident have a very low incidence of infection, lower than any other population of hospitalized patients. Infants susceptible to early-onset postnatal infections are primarily those born prematurely. Those premature infants born to mothers with an infection or whose membranes rupture more than 18 hours before delivery may have an infection rate of 20% or more.

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Publisher: Cambridge University Press
Print publication year: 2008

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