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Sepsis and Meningitis at Prematurity

Yıl 2017, Cilt: 9 Sayı: 4, 50 - 63, 20.07.2017

Öz

Abstract

Neonatal sepsis is a clinical syndrome in which systemic infection signs andsymptoms occur in the first month of life. Despite the advancements in the field ofneonatology, it is a major cause of mortality and morbidity in preterm infants. A swift diagnosis and appropriate antibiotics are life-saving. The diagnosis is based on bothclinical and laboratory findings. Isolation of the microorganism is the gold standard test for diagnosis. The microorganisms associated with neonatal sepsis and neonatal meningitis are the same and they vary depending on postnatal and gestational age. Over the last several years even though the mortality rates have decreased, the morbidity rates of neonatal meningitis still remain high. The aim of this review is to evaluate the epidemiology, etiology, pathogenesis, clinical findings and treatment of sepsis and meningitis in preterm infants.

Kaynakça

  • Kaynaklar 1.Edwards MS. Postnatal Bacterial Infections. In: Martin RJ,Fanaroff AA, Walsh MC, editors. Fanaroff and Martin's Neo-natal- Perinatal Medicine Diseases of the Fetus and Infant.9th ed. Philadelphia: Elsevier Mosby; 2011:793-840. 2.Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shan-karan S, et al. JAMA Trends in Care Practices, Morbidity, andMortality of Extremely Preterm Neonates, 1993-2012.2015;314(10):1039-51. 3.Tricia L. Gomella: Sepsis. In: Tricia L. Gomella et al (eds):Neonatology: Management, Procedures, On-call Problems,Diseases, and Drugs. New York: McGraw-Hill, 2013:865-74. 4.Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Eh-renkranz RA, et al. Changes in pathogens causing early-on-set sepsis in very-low-birth-weight infants. N Engl J Med2002;347(4):240-7. 5.Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Eh-renkranz RA, et al. Late-onset sepsis in very low birth weightneonates: the experience of the NICHD Neonatal Research Net-work. Pediatrics 2002;110(2):285-91. 6.Stoll BJ, Hansen NI, Higgins RD, Fanaroff AA, Duara S, Gold-berg R, et al; National Institute of Child Health and HumanDevelopment. Very low birth weight preterm infants with earlyonset neonatal sepsis: the predominance of gram-negative in-fections continues in the National Institute of Child Health andHuman Development Neonatal Research Network, 2002-2003.Pediatr Infect Dis J 2005;24(7):635-9. 7.Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, VanMeurs KP, et al; Eunice Kennedy Shriver National Instituteof Child Health and Human Development Neonatal ResearchNetwork. Early onset neonatal sepsis: the burden of group BStreptococcal and E. coli disease continues. Pediatrics2011;127(5):817-26. 8.Nizet V, Klein JO. Bacterial sepsis and meningitis. In: Reming-ton JS, Klein JO, Wilson CB, Baker CJ (eds). Infectious Di-seases of the Fetus and Newborn Infant (7th ed). Philadelp-hia: Elsevier Saunders, 2011: 222-75. 9.Sgro M, Shah PS, Campbell D, Tenuta A, Shivananda S, LeeSK; Canadian Neonatal Network. Early-onset neonatal sep-sis: rate and organism pattern between 2003 and 2008. J Pe-rinatol 2011;31(12):794-8. 10.Vergnano S, Menson E, Kennea N, Embleton N, Russell AB,Watts T, et al. Neonatal infections in England: the NeonIN sur-veillance network. Arch Dis Child Fetal Neonatal Ed2011;96(1):F9-14. 11. Rønnestad A, Abrahamsen TG, Medbø S, Reigstad H, Lossi-us K, Kaaresen PI, et et al. Septicemia in the first week of lifein a Norwegian national cohort of extremely premature infants.Pediatrics 2005;115(3):e262-8. 12. Arısoy ES. Yenidoğan sepsisi: tanı ve tedavi yaklaşımları. AN-KEM Derg 2010; 24(2): 168-75. 13. Ozkan H, Cetinkaya M, Koksal N, Celebi S, Hacımustafaog-lu M. Culture-proven neonatal sepsis in preterm infants in aneonatal intensive care unit over a 7 year period: coagulasenegative Staphylococcus as the predominant pathogen. Pedi-atr Int 2014;56(1): 60-6. 14. Waters D, Jawad I, Ahmad A, LukšićI, Nair H, Zgaga L, etal. Aetiology of community-acquired neonatal sepsis in lowand middle income countries. J Glob Health. 2011;1(2):154-70. 15. Brook I, Frazier EH. Microbiology of scalp abscess in new-borns. Pediatr Infect Dis J 1992;11 (9):766-8. 16. Polin RA, Denson S, Brady MT; Committee on Fetus and New-born; Committee on Infectious Diseases. Epidemiology anddiagnosis of health care-associated infections in the NICU.Pediatrics 2012;129(4):e1104-9. 17. Sohn AH, Garrett DO, Sinkowitz-Cochran RL, Grohskopf LA,Levine GL, Stover BH, Siegel JD, Jarvis WR; Pediatric Prevention Network. Prevalence of nosocomial infections in neo-natal intensive care unit patients: Results from the first natio-nal point-prevalence survey. J Pediatr. 2001;139(6):821-7. 18. Ng PC, Li K, Wong RP, Chui K, Wong E, Li G, Fok TF. Pro-inflammatory and anti-inflammatory cytokine responses in pre-term infants with systemic infections. Arch Dis Child Fetal Neo-natal Ed. 2003;88(3):F209-13. 19. Polin RA; Committee on Fetus and Newborn. Managementof neonates with suspected or proven early-onset bacterial sep-sis. Pediatrics 2012;129(5):1006-15. 20. Arnon S, Litmanovitz I. Diagnostic tests in neonatal sepsis.Curr Opin Infect Dis 2008; 21(3): 223–7. 21. Rozycki HJ, Stahl GE, Baumgart S. Impaired sensitivity of asingle early leukocyte count in screening for neonatal sepsis.Pediatr Infect Dis J 1987; 6(5): 440-2 22. Benitz WE. Adjunct laboratory tests in the diagnosis of early-onset neonatal sepsis. Clin Perinatol. 2010;37(2):421-38. 23. Gonzalez BE, Mercado CK, Johnson L, Brodsky NL, Bhan-dari V. Early markers of late-onset sepsis in premature neo-nates: clinical, hematological and cytokine profile. J PerinatMed 2003; 31(1): 60-8. 24. Auriti C, Fiscarelli E, Ronchetti MP, Argentieri M, Marroc-co G, Quondamcarlo A, et al. Procalcitonin in detecting neo-natal nosocomial sepsis. Arch Dis Child Fetal Neonatal Ed2012;97(5):F368-70. 25.Satar M, Arısoy: Yenidoğan Enfeksiyonları Tedavi ve İzlem Reh-beri. Türk Neonatoloji Derneği Rehberleri 2014: 6-27. 26. Shah BJ, Padbury JF. Neonatal sepsis an old problem withnew insights. Virulence. 2014; 5(1): 170-8. 27. Cetinkaya M, Ozkan H, Köksal N, Celebi S, Hacimustafaoğ-lu M Comparison of serum amyloid A concentrations with tho-se of C-reactive protein and procalcitonin in diagnosis andfollow-up of neonatal sepsis in premature infants. J Perina-tol 2009; 29(3): 225-31. 28. Verani JR, McGee L, Schrag SJ; Division of Bacterial Disea-ses, National Center for Immunization and Respiratory Disea-ses, Centers for Disease Control and Prevention (CDC). Pre-vention of perinatal group B streptococcal disease--revisedguidelines from CDC, 2010. MMWR Recomm Rep.2010;59(RR-10):1-36. 29. Manzoni P, Rizzollo S, Decembrino L, Ruffinazzi G, Rossi Ric-ci A, Gallo E, et al. Recent advances in prevention of sepsisin the premature neonates in NICU. Early Hum Dev2011;87(1):S31-3. 30. Cleminson J, Austin N, McGuire W. Prophylactic systemic an-tifungal agents to prevent mortality and morbidity in very lowbirth weight infants. Cochrane Database Syst Rev 2015;10:CD003850. 31. Muller-Pebody B, Johnson AP, Heath PT, Gilbert RE, Hen-derson KL, Sharland M; iCAP Group (Improving AntibioticPrescribing in Primary Care). Empirical treatment of neona-tal sepsis: are the current guidelnes adequate? Arch Dis ChildFetal Neonatal Ed 2011;96(1):F4-8. 32. van den Hoogen A, Gerards LJ, Verboon-Maciolek MA, Fle-er A, Krediet TG. Long-term trends in the epidemiology of neo-natal sepsis and antibiotic susceptibility of causative agents.Neonatology 2010;97(1):22-8. 33. Ferrieri P, Wallen LD. Neonatal bacterial sepsis. In: Glea-son CA, Devaskar SU (eds). Avery’s Diseases of the Newborn(9th ed). Philadelphia: Elsevier Saunders, 2012: 538-51. 34. Moorman JR, Carlo WA, Kattwinkel J, Schelonka RL, Por-celli PJ, Navarrete CT, et al. Mortality reduction by heart ratecharacteristic monitoring in very low birth weight neonates:a randomized trial. J Pediatr 2011;159(6):900-6. 35. Carr R, Modi N, Doré C. G-CSF and GM-CSF for treatingor preventing neonatal infections. Cochrane Database Syst Rev2003;(3):CD003066. 36. Vouloumanou EK, Plessa E, Karageorgopoulos DE, Manta-dakis E, Falagas ME. Serum procalcitonin as a diagnostic mar-ker for neonatal sepsis: a systematic review and meta-analy-sis. Intensive Care Med. 2011;37(5):747-62. 37. Ohlson A, Lacy JB. Intravenous immunoglobulin for suspec-ted or proven infection in neonates. Cochrane Database SystRev 2015;(3):CD001239. 38. Pammi M, Haque KN. Pentoxifyline for treatment of sepsisand necrotizing enterocolitis in neonates. Cochrane Databa-se Syst Rev 2015;(3):CD004205. 39. Kaufman DA, Blackman A, Conaway MR, Sinkin RA. Nons-terile glove use in addition to hand hygiene to prevent late-onset infection in preterm infants: randomized clinical trial.JAMA Pediatr 2014;168(10):909-16. 40. Larson EL. APIC guideline for handwashing and hand anti-sepsis in health care settings. Am J Infect Control1995;23(4):251-69. 41. Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, HintzSR, Vohr B, Higgins RD; National Institute of Child Healthand Human Development Neonatal Research Network. Neu-rodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA2004;292(19):2357-65. 42. Heath PT, Okike IO, Oeser C. Neonatal meningitis: can wedo better? Adv Exp Med Biol 2011; 719: 11-24. 43. Ku LC, Boggess KA, Cohen-Wolkowiez M Bacterial menin-gitis in infants. Clin Perinatol 2015; 42(1): 29-45. 44. Garges HP, Moody MA, Cotten CM, Smith PB, Tiffany KF, Len-festey R, et al. Neonatal meningitis: what is the correlation amongcerebrospinal fluid cultures, blood cultures, and cerebrospinalfluid parameters? Pediatrics 2006;117(4):1094-100. 45. Volpe JJ. Bacterial and fungal intracranial infections. In: Neu-rology of the newborn, 5th ed, WB Saunders Company, Phi-ladelphia 2008. p.916-43. 46. Unhanand M, Mustafa MM, McCracken GH Jr, Nelson JD.Gram-negative enteric bacillary meningitis: a twenty-one-yearexperience. J Pediatr 1993;122(1):15-21. 47. Pong A, Bradley JS. Bacterial meningitis and the newborn in-fant. Infect Dis Clin North Am 1999;13(3):711-33. 48. Biswas B, Mondal M, Thapa R, Mallick D, Datta AK. Neo-natal Brain Abscess due to Extended-Spectrum Beta-Lacta-mase Producing Klebsiella pneumoniae. J Clin Diagn Res2014;8(11):PD01-2. 49. Hoffman HJ, Hendrick EB, Hiscox JL. Cerebral abscesses inearly infancy. J Neurosurg 1970;33(2):172-7.

Prematürede Sepsis ve Menenjit

Yıl 2017, Cilt: 9 Sayı: 4, 50 - 63, 20.07.2017

Öz

Öz

Neonatal sepsis yaşamın ilk ayı içerisinde sistemik enfeksiyon bulgu ve semptomlarının olduğu klinik bir sendromdur. Neonatoloji alanındaki gelişmelere rağmensepsis prematüre bebeklerde major mortalite ve morbidite nedenlerinden birisi olup yenidoğan yoğun bakım ünitelerindeki (YDYBÜ) en önemli sorunlardan birini oluşturmaktadır. Tanının hızlı bir şekilde konarak uygun antibiyotik ve destek tedavisinin başlanması hayat kurtarıcıdır. Sepsis tanısı klinik ve laboratuvar bulgularının birlikte değerlendirilmesi ile konulmaktadır. Mikroorganizmanın kanda izolasyonu enspesifik yöntemdir ve altın standart olarak kabul edilmektedir. Bakteriyel menenjitler de yenidoğan döneminde yüksek mortalite ve morbiditeye neden olan ciddi en-feksiyonlardır. Yenidoğan menenjitinde görülen mikroorganizmalar postnatal ve gebelik yaşına bağlıdır ve yenidoğan sepsisi ile aynıdır. Son yıllarda mortalite oranı azalsa da yenidoğan menenjitinin morbidite oranı pek değişim göstermemiştir. Bu derlemede prematüre bebeklerde görülen sepsis ve menenjitin epidemiyolojisi, etiyolojisi,patogenezi, klinik bulguları ve yaklaşımının gözden geçirilmesi amaçlanmıştır.

Kaynakça

  • Kaynaklar 1.Edwards MS. Postnatal Bacterial Infections. In: Martin RJ,Fanaroff AA, Walsh MC, editors. Fanaroff and Martin's Neo-natal- Perinatal Medicine Diseases of the Fetus and Infant.9th ed. Philadelphia: Elsevier Mosby; 2011:793-840. 2.Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shan-karan S, et al. JAMA Trends in Care Practices, Morbidity, andMortality of Extremely Preterm Neonates, 1993-2012.2015;314(10):1039-51. 3.Tricia L. Gomella: Sepsis. In: Tricia L. Gomella et al (eds):Neonatology: Management, Procedures, On-call Problems,Diseases, and Drugs. New York: McGraw-Hill, 2013:865-74. 4.Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Eh-renkranz RA, et al. Changes in pathogens causing early-on-set sepsis in very-low-birth-weight infants. N Engl J Med2002;347(4):240-7. 5.Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Eh-renkranz RA, et al. Late-onset sepsis in very low birth weightneonates: the experience of the NICHD Neonatal Research Net-work. Pediatrics 2002;110(2):285-91. 6.Stoll BJ, Hansen NI, Higgins RD, Fanaroff AA, Duara S, Gold-berg R, et al; National Institute of Child Health and HumanDevelopment. Very low birth weight preterm infants with earlyonset neonatal sepsis: the predominance of gram-negative in-fections continues in the National Institute of Child Health andHuman Development Neonatal Research Network, 2002-2003.Pediatr Infect Dis J 2005;24(7):635-9. 7.Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, VanMeurs KP, et al; Eunice Kennedy Shriver National Instituteof Child Health and Human Development Neonatal ResearchNetwork. Early onset neonatal sepsis: the burden of group BStreptococcal and E. coli disease continues. Pediatrics2011;127(5):817-26. 8.Nizet V, Klein JO. Bacterial sepsis and meningitis. In: Reming-ton JS, Klein JO, Wilson CB, Baker CJ (eds). Infectious Di-seases of the Fetus and Newborn Infant (7th ed). Philadelp-hia: Elsevier Saunders, 2011: 222-75. 9.Sgro M, Shah PS, Campbell D, Tenuta A, Shivananda S, LeeSK; Canadian Neonatal Network. Early-onset neonatal sep-sis: rate and organism pattern between 2003 and 2008. J Pe-rinatol 2011;31(12):794-8. 10.Vergnano S, Menson E, Kennea N, Embleton N, Russell AB,Watts T, et al. Neonatal infections in England: the NeonIN sur-veillance network. Arch Dis Child Fetal Neonatal Ed2011;96(1):F9-14. 11. Rønnestad A, Abrahamsen TG, Medbø S, Reigstad H, Lossi-us K, Kaaresen PI, et et al. Septicemia in the first week of lifein a Norwegian national cohort of extremely premature infants.Pediatrics 2005;115(3):e262-8. 12. Arısoy ES. Yenidoğan sepsisi: tanı ve tedavi yaklaşımları. AN-KEM Derg 2010; 24(2): 168-75. 13. Ozkan H, Cetinkaya M, Koksal N, Celebi S, Hacımustafaog-lu M. Culture-proven neonatal sepsis in preterm infants in aneonatal intensive care unit over a 7 year period: coagulasenegative Staphylococcus as the predominant pathogen. Pedi-atr Int 2014;56(1): 60-6. 14. Waters D, Jawad I, Ahmad A, LukšićI, Nair H, Zgaga L, etal. Aetiology of community-acquired neonatal sepsis in lowand middle income countries. J Glob Health. 2011;1(2):154-70. 15. Brook I, Frazier EH. Microbiology of scalp abscess in new-borns. Pediatr Infect Dis J 1992;11 (9):766-8. 16. Polin RA, Denson S, Brady MT; Committee on Fetus and New-born; Committee on Infectious Diseases. Epidemiology anddiagnosis of health care-associated infections in the NICU.Pediatrics 2012;129(4):e1104-9. 17. Sohn AH, Garrett DO, Sinkowitz-Cochran RL, Grohskopf LA,Levine GL, Stover BH, Siegel JD, Jarvis WR; Pediatric Prevention Network. Prevalence of nosocomial infections in neo-natal intensive care unit patients: Results from the first natio-nal point-prevalence survey. J Pediatr. 2001;139(6):821-7. 18. Ng PC, Li K, Wong RP, Chui K, Wong E, Li G, Fok TF. Pro-inflammatory and anti-inflammatory cytokine responses in pre-term infants with systemic infections. Arch Dis Child Fetal Neo-natal Ed. 2003;88(3):F209-13. 19. Polin RA; Committee on Fetus and Newborn. Managementof neonates with suspected or proven early-onset bacterial sep-sis. Pediatrics 2012;129(5):1006-15. 20. Arnon S, Litmanovitz I. Diagnostic tests in neonatal sepsis.Curr Opin Infect Dis 2008; 21(3): 223–7. 21. Rozycki HJ, Stahl GE, Baumgart S. Impaired sensitivity of asingle early leukocyte count in screening for neonatal sepsis.Pediatr Infect Dis J 1987; 6(5): 440-2 22. Benitz WE. Adjunct laboratory tests in the diagnosis of early-onset neonatal sepsis. Clin Perinatol. 2010;37(2):421-38. 23. Gonzalez BE, Mercado CK, Johnson L, Brodsky NL, Bhan-dari V. Early markers of late-onset sepsis in premature neo-nates: clinical, hematological and cytokine profile. J PerinatMed 2003; 31(1): 60-8. 24. Auriti C, Fiscarelli E, Ronchetti MP, Argentieri M, Marroc-co G, Quondamcarlo A, et al. Procalcitonin in detecting neo-natal nosocomial sepsis. Arch Dis Child Fetal Neonatal Ed2012;97(5):F368-70. 25.Satar M, Arısoy: Yenidoğan Enfeksiyonları Tedavi ve İzlem Reh-beri. Türk Neonatoloji Derneği Rehberleri 2014: 6-27. 26. Shah BJ, Padbury JF. Neonatal sepsis an old problem withnew insights. Virulence. 2014; 5(1): 170-8. 27. Cetinkaya M, Ozkan H, Köksal N, Celebi S, Hacimustafaoğ-lu M Comparison of serum amyloid A concentrations with tho-se of C-reactive protein and procalcitonin in diagnosis andfollow-up of neonatal sepsis in premature infants. J Perina-tol 2009; 29(3): 225-31. 28. Verani JR, McGee L, Schrag SJ; Division of Bacterial Disea-ses, National Center for Immunization and Respiratory Disea-ses, Centers for Disease Control and Prevention (CDC). Pre-vention of perinatal group B streptococcal disease--revisedguidelines from CDC, 2010. MMWR Recomm Rep.2010;59(RR-10):1-36. 29. Manzoni P, Rizzollo S, Decembrino L, Ruffinazzi G, Rossi Ric-ci A, Gallo E, et al. Recent advances in prevention of sepsisin the premature neonates in NICU. Early Hum Dev2011;87(1):S31-3. 30. Cleminson J, Austin N, McGuire W. Prophylactic systemic an-tifungal agents to prevent mortality and morbidity in very lowbirth weight infants. Cochrane Database Syst Rev 2015;10:CD003850. 31. Muller-Pebody B, Johnson AP, Heath PT, Gilbert RE, Hen-derson KL, Sharland M; iCAP Group (Improving AntibioticPrescribing in Primary Care). Empirical treatment of neona-tal sepsis: are the current guidelnes adequate? Arch Dis ChildFetal Neonatal Ed 2011;96(1):F4-8. 32. van den Hoogen A, Gerards LJ, Verboon-Maciolek MA, Fle-er A, Krediet TG. Long-term trends in the epidemiology of neo-natal sepsis and antibiotic susceptibility of causative agents.Neonatology 2010;97(1):22-8. 33. Ferrieri P, Wallen LD. Neonatal bacterial sepsis. In: Glea-son CA, Devaskar SU (eds). Avery’s Diseases of the Newborn(9th ed). Philadelphia: Elsevier Saunders, 2012: 538-51. 34. Moorman JR, Carlo WA, Kattwinkel J, Schelonka RL, Por-celli PJ, Navarrete CT, et al. Mortality reduction by heart ratecharacteristic monitoring in very low birth weight neonates:a randomized trial. J Pediatr 2011;159(6):900-6. 35. Carr R, Modi N, Doré C. G-CSF and GM-CSF for treatingor preventing neonatal infections. Cochrane Database Syst Rev2003;(3):CD003066. 36. Vouloumanou EK, Plessa E, Karageorgopoulos DE, Manta-dakis E, Falagas ME. Serum procalcitonin as a diagnostic mar-ker for neonatal sepsis: a systematic review and meta-analy-sis. Intensive Care Med. 2011;37(5):747-62. 37. Ohlson A, Lacy JB. Intravenous immunoglobulin for suspec-ted or proven infection in neonates. Cochrane Database SystRev 2015;(3):CD001239. 38. Pammi M, Haque KN. Pentoxifyline for treatment of sepsisand necrotizing enterocolitis in neonates. Cochrane Databa-se Syst Rev 2015;(3):CD004205. 39. Kaufman DA, Blackman A, Conaway MR, Sinkin RA. Nons-terile glove use in addition to hand hygiene to prevent late-onset infection in preterm infants: randomized clinical trial.JAMA Pediatr 2014;168(10):909-16. 40. Larson EL. APIC guideline for handwashing and hand anti-sepsis in health care settings. Am J Infect Control1995;23(4):251-69. 41. Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, HintzSR, Vohr B, Higgins RD; National Institute of Child Healthand Human Development Neonatal Research Network. Neu-rodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA2004;292(19):2357-65. 42. Heath PT, Okike IO, Oeser C. Neonatal meningitis: can wedo better? Adv Exp Med Biol 2011; 719: 11-24. 43. Ku LC, Boggess KA, Cohen-Wolkowiez M Bacterial menin-gitis in infants. Clin Perinatol 2015; 42(1): 29-45. 44. Garges HP, Moody MA, Cotten CM, Smith PB, Tiffany KF, Len-festey R, et al. Neonatal meningitis: what is the correlation amongcerebrospinal fluid cultures, blood cultures, and cerebrospinalfluid parameters? Pediatrics 2006;117(4):1094-100. 45. Volpe JJ. Bacterial and fungal intracranial infections. In: Neu-rology of the newborn, 5th ed, WB Saunders Company, Phi-ladelphia 2008. p.916-43. 46. Unhanand M, Mustafa MM, McCracken GH Jr, Nelson JD.Gram-negative enteric bacillary meningitis: a twenty-one-yearexperience. J Pediatr 1993;122(1):15-21. 47. Pong A, Bradley JS. Bacterial meningitis and the newborn in-fant. Infect Dis Clin North Am 1999;13(3):711-33. 48. Biswas B, Mondal M, Thapa R, Mallick D, Datta AK. Neo-natal Brain Abscess due to Extended-Spectrum Beta-Lacta-mase Producing Klebsiella pneumoniae. J Clin Diagn Res2014;8(11):PD01-2. 49. Hoffman HJ, Hendrick EB, Hiscox JL. Cerebral abscesses inearly infancy. J Neurosurg 1970;33(2):172-7.
Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm makale
Yazarlar

Prof. Dr. Eren Özek

Yayımlanma Tarihi 20 Temmuz 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 9 Sayı: 4

Kaynak Göster

APA Özek, P. D. E. (2017). Prematürede Sepsis ve Menenjit. Klinik Tıp Pediatri Dergisi, 9(4), 50-63.
AMA Özek PDE. Prematürede Sepsis ve Menenjit. Pediatri. Temmuz 2017;9(4):50-63.
Chicago Özek, Prof. Dr. Eren. “Prematürede Sepsis Ve Menenjit”. Klinik Tıp Pediatri Dergisi 9, sy. 4 (Temmuz 2017): 50-63.
EndNote Özek PDE (01 Temmuz 2017) Prematürede Sepsis ve Menenjit. Klinik Tıp Pediatri Dergisi 9 4 50–63.
IEEE P. D. E. Özek, “Prematürede Sepsis ve Menenjit”, Pediatri, c. 9, sy. 4, ss. 50–63, 2017.
ISNAD Özek, Prof. Dr. Eren. “Prematürede Sepsis Ve Menenjit”. Klinik Tıp Pediatri Dergisi 9/4 (Temmuz 2017), 50-63.
JAMA Özek PDE. Prematürede Sepsis ve Menenjit. Pediatri. 2017;9:50–63.
MLA Özek, Prof. Dr. Eren. “Prematürede Sepsis Ve Menenjit”. Klinik Tıp Pediatri Dergisi, c. 9, sy. 4, 2017, ss. 50-63.
Vancouver Özek PDE. Prematürede Sepsis ve Menenjit. Pediatri. 2017;9(4):50-63.