Scenarios

Scenario 2: Neonatal sepsis

You are called to review Baby Duffy on the post-natal ward because the midwives have noted that she has a low temperature, seems very sleepy and is not feeding.

Her details are as follows:

Name: Female Infant Duffy
DOB: 22/2/14
Address: 6 Bow Street, London
Hospital number: 87654321
NHS number: 0820654321

Baby Duffy was born 36 hours ago at 39+5 gestation by normal vaginal delivery and required no resuscitation at birth. There was a history of prolonged rupture of membranes and her mother received antibiotics in labour. There were no other risk factors for sepsis. Baby Duffy has been having regular observations on the post-natal ward because of the history of prolonged rupture of membranes. Her birth weight was 3.45 kg.

Her temperature is 35.5°C, respiratory rate 55, heart rate 155 and oxygen saturations 97% in room air. Examining the baby you notice that she seems quite sleepy and does not rouse easily. She is warm centrally, appears pink and her capillary refill time is less than 2 sec. Anterior fontanelle is soft and she has normal tone and posture.

You are concerned about possible neonatal sepsis and want to take bloods and start the baby on antibiotics.

• 1. Which antibiotic(s) will you prescribe for the baby and at what dose?

  Show Answer

  Correct answer:
  Current NICE guidance recommends the use of benzylpenicillin and gentamicin. Most hospitals will use benzylpenicillin and gentamicin as their standard antibiotic regime for babies with suspected sepsis, but check what your local policy is. Use the BNFc to guide you for the dose in this scenario. Prescribe 25 mg/kg of benzylpenicillin every 8 hours (you may have chosen to prescribe the higher dose of 50 mg/kg if you suspected meningitis) and gentamicin 5 mg/kg every 24 hours. If there is space to do so on the drug chart, it can be helpful to write the dose you intend to give per kilogram (e.g. 25 mg/kg) so that the nurses can check your calculation using the baby's weight.
  
  Write when the blood gentamicin level needs to be checked on the drug chart and circle the relevant box to highlight this too so that it is not forgotten.
  
  See the model answer prescription chart to check your answer – all personal details, allergies and weight MUST be filled in..