Neonatal sepsis, treatment

Getttamidtt. Gentamicin is widely used in the treatment of severe infections. Uses include septicemia, neonatal sepsis, neonatal meningitis, biliary tract infection, pyelonephritis, prostatitis, and endocarditis. Gentamicin is frequently used for empiric therapy in presmned gramnegative bacillary infections before the identification and susceptibility of the causative organism are known. Patients with cystic fibrosis and those in intensive care imits often have Pseudomonas infections and are typically treated with gentamicin. 

Vinegar was used topically in a Turkish neonate with suspected sepsis (1). The child was treated with antibiotics and his grandmother decided in addition to rub his upper thorax, back, and arms with vinegar. As a result the child developed chemical burns on the treated areas. Fortunately he made a full recovery after the grandmother stopped the treatment. 

Despite the high success rates, 20% of neonates fail to respond to treatment. Factors associated with poor response inclnde sepsis, pnenmonia, PDA, congenital heart disease, pulmonary hypertension, meconium aspiration, and pulmonary hypoplasia. - Whether retreatment of RDS with surfactant after resolution of these factors is nsefnl is currently unknown. 

Supplemental vitamin A is used in some neonatal treatment centers to reduce the risk of BPD and sepsis in preterm infants. However, concern over the risk of vitamin A toxicity (i.e., posthemorrhagic hydrocephalus or liver disease) and sequelae from repeated intramuscular injections of vitamin A prevent its widespread use. 

Disorders of the intestinal tract in the neonatal period usually present with abdominal distension and dilatation of the bowel. However, not all intestinal dilatations represent obstruction. Infants with medical disorders such as sepsis, electrolyte imbalance or necrotizing enterocolitis may present ileus characterized by uniform dilatation of the bowel to the level of the rectum. Also, infants on continuous positive airways pressure may swallow an excessive amount of air and exhibit important intestinal dilatation. This dilatation must be distinguished from mechanical obstruction, because the treatment is completely different. The differentiation between these two categories can usually be made on the basis of clinical history, laboratory tests, and appropriate radiographs (Hernanz-SCHULMAN 1999). 

ECMO is considered a standard therapy for the treatment of respiratory failure in neonatal patients (Anderson and Bartlett, 2000). In adult and pediatric patients, it is a treatment of last resort for individuals who would otherwise die despite maximal therapy (Anderson and Bartlett, 2000 Bartlett et al., 2000). Even in neonatal cases, ECMO is a therapy reserved for those patients with severe respiratory compromise and a high risk of death who are failing traditional ventilator-based interventions. Common causes of respiratory failure in the neonatal population that are treatable with ECMO support include pneumonia or sepsis, meconium aspiration syndrome, respiratory distress syndrome, persistent fetal circulation, and congenital diaphragmatic hernia (Anderson and Bartlett, 2000). Contraindications to ECMO support include root causes that are unresolvable, such as a major birth defect or genetic abnormality, and comorbid conditions such as intracranial hemorrhage or fetal underdevelopment that suggest a poor outcome (Anderson and Bartlett, 2000). Indications for ECMO use in the pediatric and adult populations are not dissimilar from those of the neonate, but... 

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