Common Infections. Skin Infections

Most skin infections in the newborn are caused by staphylococci. The usual lesions are small pustules or a mild paronychia. Occasionally the skin around the umbilicus may become red and edematous indicating a more virulent umbilical stump infection than usual. In mild skin infections swabs should be taken from the infected areas which can then be painted with crystal violent paint of 0.2 percent. More severe infections might lead to staphylococcal septicemia, pneumonia or osteomyelitis and should be treated with an appropriate systemic antibiotic such as cefazolin.

Thrush. Monilia infection is usually mild and affects the mouth and perianal skin. In the mouth there are small white plaques on the inside of the cheek or on the tongue which look like curds of milk but do not wipe off, the fungus passes down the alimentary tract and sets up a mild perianal skin infection which appears as a uniform erythema. In more severe cases, which are rare, the lung may be involved. Thrush is treated with nystatin mixture, 100 000 units in 1 ml four times a day after feeds. Nystatin cream aids the perianal skin.

Gastroenteritis. Fortunately this is now an uncommon infection in the newborn but when it occurs, it may give rise to a nursery epidemic. It is therefore wise to take particular notice of newborns that develop diarrhea. The pathogenic organism may be colibacillus (E. coli) or a virus or one of the salmonella group. As at gastroenteritis in another child, dehydration is the main problem and must be rapidly corrected. Antibiotic therapy should be used too.

Urinary Tract Infections. The diagnosis of urinary tract infection can be made only on revealing a significant bacteriuria and pyuria on a fresh clean specimen of urine. The baby is held out with its legs apart, the skin of the perineal area is stroked to stimulate micturition and the voided urine (after the first drops) is collected in a sterile container. In cases of urgency urine can usually be obtained by suprapubic bladder aspiration. Leucocyte counts of over 10 per cm³ and bacterial counts of more than 10⁵ per ml on two consecutive specimens establish the diagnosis. The usual organism is E. coli. Although most of the babies with urinary tract infection will have a mild illness, some will be seriously ill with septicemia and jaundice. Appropriate antibiotics should be given and follow up should be arranged to decide on the need for radiological investigation of the urinary tract.

Pneumonia. Certain adverse factors during labor and delivery predispose to neonatal pneumonia, for example difficult delivery, infected liquor and aspiration of meconium. Gram-negative organisms are predominant. The baby appears ill and may have few respiratory symptoms. There may be recession of the chest wall, cyanosis, and tachypnea. X-rays should be taken to establish the diagnosis.

The meconium aspiration syndrome is caused by aspiration of meconium stained liquor during birth and is associated with asphyxia and post-term delivery. There are patchy areas of airway, obstruction and atelectasis and infection may be superimposed. The clinical picture may be difficult to distinguish at early onset of pneumonia but the radiological features of meconium aspiration are characteristic.

Meningitis. The disease is about four times commoner in pre-term than in full-term babies. The organisms are usually Gram-negative; E. coli and Ps. aeruginosa are the most common. The onset is usually in the first week and often on the first day, gradual with fever, poor feeding and vomiting as the commonest symptoms. The classical signs of meningitis are usually absent and lumbar puncture should be performed early in sick babies who have no obvious cause for their illness. Blood culture should be carried out to help in identifying the organism. Antibiotic therapy should be started as soon as possible, the choice of antibiotic depending on the obtained information about the organism.