Septic Shock In Newborns

Posted by e-Medical PPT Sunday, July 8, 2012
Systemic inflammatory response manifested by >2:
Temperature > 38 or < 36 C Heart Rate >90bpm
Respiratory Rate >20 or PaCO2 < 32 mmHg WBC > 12.000/ul, < 4000u/l or 10% immature cells Sepsis:Systemic inflammatory response to a documented infection. SIRS manifestations + at least 1 of inadequate organ perfusion manifestations : Alteration in mental state Hypoxemia (PaO2 < 72 mmHg) Elevated plasma lactate level Oliguria (<0.5 ml/kg/hr) Septic shock A subset of patient with severe sepsis develop hypotension despite adequate fluid resuscitation, along with presence of all manifestations of inadequate organ function/perfusion Hemodynamics in neonatal septic shock have not been systematically studied Inflammatory mediators are key players in pathogenesis Proinflammatory cytokines induced in host cells (macrophages /monocytes / neutrophils) by bacterial cell wall component Activation complement system ⇨ Clearance of infecting microorganisms + enhances tissue damage Hypotension, the cardinal manifestation of sepsis, occurs via induction of nitric oxide Neutrophils dual role: Defense against microorganisms Become toxic inflammatory mediators Multiorgan dysfunction syndrome Described as auto destructive process that permits extension of normal pathophysiologic response to infection, resulting in multiple organ dysfunction syndrome. Organ dysfunction or failure may be the first clinical sign of sepsis, and no organ system is immune to the consequences of the inflammatory excesses of sepsis. - Hypoxia - Direct cytotoxicity - Apoptosis - Immunosuppression - Coagulopathy
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