Is this baby eligible for INIS?

1. Is this baby eligible for INIS?

2. 23 weeks gestation, birth weight 475g • Day 3 - reduced activity on ventilator, looks seriously ill • Screening bloods - CRP 45mg/l,platelets 88 • Antibiotics commenced • Confirmation of infection day 2 with GBS on blood culture

3.  • 23 weeks gestation, birth weight 475g • Day 3 - reduced activity on ventilator, looks seriously ill • Screening bloods - CRP 45mg/l,platelets 88 • Antibiotics commenced • Confirmation of infection day 2 with GBS on blood culture

4. 26 weeks gestation, birth weight 950g • Day 4, deterioration on ventilator • Increasing oxygen requirement to 80% • Appears unwell • ETS recently grown coagulase negative staphylococci and CXR consistent with pneumonia • Antibiotics commenced

5.  • 26 weeks gestation, birth weight 950g • Day 4, deterioration on ventilator • Increasing oxygen requirement to 80% • Appears unwell • ETS recently grown coagulase negative staphylococci and CXR consistent with pneumonia • Antibiotics commenced

6. 27 weeks gestation, 1.3kg • PROM 27 hrs • GBS on maternal HVS • Intrapartum antibiotics not given • Asymptomatic infant • Antibiotics commenced as hospital policy

7.  • 27 weeks gestation, 1.3kg • PROM 27 hrs • GBS on maternal HVS • Intrapartum antibiotics not given • Asymptomatic infant • Antibiotics commenced as hospital policy

8. 27 weeks gestation, birth weight 1360g • Day 38 intermittent bradycardias, then apnoeas resulting in ventilation • Distended, tender abdomen noted with bilious aspirates • Serial AXRs confirm fixed, oedematous bowel loops • NEC diagnosed and antibiotics commenced

9.  • 27 weeks gestation, birth weight 1360g • Day 38 intermittent bradycardias, then apnoeas resulting in ventilation • Distended, tender abdomen noted with bilious aspirates • Serial AXRs confirm fixed, oedematous bowel loops • NEC diagnosed and antibiotics commenced

10. Term infant • Cyanotic episodes at 2hrs age • Increasing oxygen requirement • CXR patchy consolidation both lung fields • Commenced on antibiotics • CRP 19

11.  • Term infant • Cyanotic episodes at 2hrs age • Increasing oxygen requirement • CXR patchy consolidation both lung fields • Commenced on antibiotics • CRP 19

12. But • If there was offensive liquor, raised inflammatory markers or this baby was to become unwell This baby would be eligible for INIS

13. Deterioration day 34 • Recurrent apnoeic episodes • Prolonged cap. refill time • CRP 66 • Commenced on antibiotics • 29 weeks gestation • Positive blood culture

14.  • Deterioration day 34 • Recurrent apnoeic episodes • Prolonged cap. refill time • CRP 66 • Commenced on antibiotics • 29 weeks gestation • Positive blood culture

15. Remember • It is NOT TOO LATE to randomise an infant after a positive blood culture has been reported • IVIG may be of benefit after the inflammatory process has begun

16. Every baby counts • Consider all babies to be eligible for INIS • Make sure everyone knows you are the INIS nurse • Make sure they know you do not have to be there for them to recruit a baby into INIS • Remember an ANNP can get consent • Doctors need to write up the prescription