Home

Neonatal septicemia in puppies treatment

Background: In humans, transmission of bacteria causing fatal sepsis in the neonates through mother's milk has been reported. In dogs, it is believed that bacteria from canine milk are not the primary cause of neonatal infections. Staphylococcus pseudintermedius is colonizing the skin and mucocutaneous junctions in adult dogs and can act as an opportunistic pathogen These puppies should be treated immediately: gradual warming, turning and massage of the body, rehydration and nutrient supply and probiotics, sometimes also including antibiotics Equine neonatal sepsis: treatment (Proceedings) August 1, 2011. Allison Stewart, BVSc (hons), MS, DACVIM-LAIM, DACVECC. If the foal is less than 12 hours, it can be given 1-3 liters of high quality (sp gr > 1.090) colostrum. (Frozen colostrum should be thawed in warm water, rather than the microwave. Ideally colostrum should be < 12 months old) Treatment options include long-term antibiotic therapy or surgical resection. Many septic foals will develop a patent urachus without involvement of other structures; the reported incidence in septic foals is 21%. 63 This problem will often resolve with continued antibiotic therapy, with or without topical therapy The supportive treatment with antibiotics, IV fluids and oxygen was reinstituted. Additionally, puppies were separated from the dam and put back onto the formula for the whole week. Milk samples from the dam were collected for the bacteriological examination

Given the difficulties in adequately assessing hypovolemia in neonates, all neonates with severe diarrhea, inadequate intake, or severe vomiting should be assumed to be dehydrated and hypovolemic, and treatment should be initiated immediately. Treatment includes fluid therapy, monitoring of electrolyte and glucose status, and nutritional support Withdrawing the puppies and feeding them artificially will protect the litter from the risks of embolization of intestinal germs (septicemia). The presence of cutaneous abscesses (staphylococcic) in the mother can also cause neonatal septicemia in puppies Septic shock in dogs treatment requires the administration of intravenous fluids, oxygen and medication to restore the body's balance (in addition to antibiotics). Unfortunately, septic shock is extremely severe and carries a higher risk of fatality. Remember that all of the medication above must be prescribed by a veterinarian Antibiotic treatments for calves with scours are not so much for the scours as they are for reducing the risk of septicemia, says Windeyer. Early recognition of clinical signs associated with septicemia is critical to treatment success. Broad-spectrum antibiotics and supportive care are recommended for treatment of septicemia Treatment For Sepsis In Babies The treatment depends on the baby's age, health condition, and the infection's severity. If a baby is diagnosed with sepsis, they are hospitalized, and intravenous antibiotic treatment begins immediately. Additionally, the baby could receive intravenous fluids, special nutrition, and other medications

Treatment for Neonatal Sepsis. The treatment is mainly focused on fighting and flushing out the infection from infant's body. A pre-emptive treatment of giving Intravenous liquid must be done even before the infant is diagnosed. Once the cause is known then particular targeted treatments must be given Antimicrobial medications are the most commonly used medications in the neonatal intensive care unit. Antibiotics are used for infection prophylaxis, empiric treatment, and definitive treatment of confirmed infection. The choice of medication should be informed by the epidemiology and microbiology o Treatments that should be immediately instituted for sick puppies and kittens include heat support (until rectal temperature reaches normal for age of neonate - do not overheat!), nutritional support (tube feeding or IV/IO dextrose), antibiotics, and fluid support separated from the mother's care. Neonatal puppies are unable to maintain body temperature in a cold environment up to 6 days after birth. They are not able to produce heat by shivering (Fox 1966), and brown adi-pose tissue as the source of non-shivering thermogenesis Table 2. Interval from birth to death in neonatal puppies* Interval birth. Introduction. Despite advances in neonatal care leading to improved survival rates and reduced complications in preterm infants (), there has been little improvement in the prophylaxis, treatment, and adverse neurodevelopmental outcomes associated with neonatal sepsis over the last three decades (2-5).The incidence of neonatal sepsis is inversely correlated with gestational age (GA) and.

Neonatal Disease in Puppies - BSAVA2008 - VI

Fading puppy syndrome describes puppies that decline in health and die within about two weeks of birth. Neonatal puppies are fragile and so there can be many causes of this syndrome including birth defects, inadequate care from the mother, poor health status of the mother and/or infectious diseases. As well as addressing a specific cause, treatment focuses on maintaining hydration and warmth. gentamicin for empiric treatment of neonates with suspected clinical sepsis; when referral is not possible, once daily gentamicin plus oral amoxicillin may be used. It is known, however, that in many countries, agents with a broader spectrum, such as -generation cephalosporinthird s, are commonly used to treat neonatal and infant sepsi The management of neonatal sepsis is highly heterogeneous . Clinical trials evaluating the treatment of neonatal sepsis are scarce and failed to find an optimal antibiotic regimen . The lack of an accepted definition of sepsis in neonates is one of the main obstacles for the performance of these trials

With improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. The identification of neonates at risk for early-onset sepsis is frequently based on a constellation of perinatal. assessment and treatment, as well as discharge planning, in order to ensure timely treatment in an effort to reduce morbidity and mortality. Policy/Criteria It is the policy of Health Plans affiliated with Centene Corporation that the management of neonatal sepsis is medically necessary at the indicated level of care for the followin Historically, the treatment approach for suspected neonatal sepsis has included early aggressive initiation of antibiotics because of the neonate's relative immunosuppression. Because early signs of sepsis in the newborn are nonspecific, diagnostic studies are often ordered and treatment initiated in neonates before the presence of sepsis has. Abstract. Background: Neonatal sepsis is a systemic inflammatory response syndrome in the presence of or as a result of suspected or proven infection in a neonate. It is a leading cause of neonatal morbidity and mortality, particularly in developing countries. The clinical outcomes of neonatal sepsis vary in different hospitals with different setups Treatment of Neonatal Sepsis. The main focus of the treatment is on combating and flushing out the infection from the newborn baby's body. This is done by providing an intravenous (IV) fluid.

Equine neonatal sepsis: treatment (Proceedings

Neonatal Septicemia Veterian Ke

Overview What is sepsis in newborns? Sepsis is a serious medical condition caused by the body's response to an infection. A newborn who has an infection and develops sepsis can have inflammation (swelling) throughout the body, leading to organ failure INTRODUCTION. Bacterial meningitis is more common in the first month than at any other time of life [ 1 ]. Despite advances in neonatal intensive care, meningitis in the neonate remains a devastating disease. The treatment and outcome of bacterial meningitis in the neonate (age <1 month) will be discussed here sepsis (LOS) therapy to cover coagulase-negative staphylococci (CoNS), which are usually resistant to narrower spectrum antibiotics. Though CoNS is one of the most common causes of LOS, it is unlikely to lead to near term mortality compared to other LOS 1,2pathogens. Empiric treatment vs. delayed treatment of CoNS (initiation o Wichtel M E et al (1999) Pharmacologic considerations in the treatment of neonatal septicaemia and its complications. Vet Clin North Am Equine Pract 15 (3), 725-746 PubMed. Paradis M R (1994) Update on neonatal septicemia. Vet Clin North Am Equine Pract 10 (1), 109-135 PubMed 4. List signs and symptoms of neonatal sepsis 5. Describe at least 3 common pathogens in the NICU 6. Discuss diagnostic tests used in diagnosis of sepsis 7. Describe nursing interventions for a septic infant Introduction There have been many advances in prevention, assessment and treatment of neonatal sepsis in the past few decades

Neonatal sepsis occurs in 1 to 8 per 1000 live births with the highest incidence occurring among infants of very low birth weight and gestation. Please note: It is mandatory to have a high index of suspicion for the possibility of sepsis, as well as a low threshold for commencing antibiotic treatment Neonatal sepsis is a major cause of hospitalization and infant death and can result from meningitis, pneumonia, gastroenteritis, or other serious infections. Early detection and treatment can reduce morbidity and mortality, but nonspecific symptoms cause difficulty in differentiating bacterial and viral infections Early Onset Sepsis in Neonates Page 2 of 9 24/05/2018 # At least 12 hrs of observations; 0hrs, 1hr, 2hrs and 2hrly for 12 hrs (on neonatal observation chart - including temperature, colour, capillary re fill time, HR, RR) If there is maternal GBS then observations to continue until 24h of age (4hrly from 12-24 hrs

Canine Neonatal Disorder

Bacterial Infection of the Blood (Sepsis) in Dogs. Bacteremia and septicemia occur when the persistent presence of bacterial organisms in a dog's bloodstream becomes systemic, meaning that it has spread throughout the body. This is also referred to as blood poisoning, and septic fever Neonatal Sepsis: Causes, Signs, and Treatment. Neonatal sepsis is an infection that affects infants and it can be fatal, if treatment is not given early. This article provides some information about the causes, symptoms, and treatments of this medical condition Treatment of Bacterial Sepsis of Newborn; General Description. Bacterial sepsis of newborn (neonatal sepsis) is a generalized infectious disease, manifested with suppurative focus, bacteremia, systemic inflammatory response and multiple organ failures. Neonatal sepsis is provoked by potentially pathogenic bacterial microflora

Neonatal sepsis remains a major cause of neonatal mortality and morbidity in preterm and very low birth weight infants [ 1-5 ]. Clinical care providers should have a high index of suspicion to diagnose infections in preterm and very low birth weight infants. Delay in initiation of appropriate antibiotic therapy can worsen clinical outcomes 14 Septic Shock in Neonates Lidia Decembrino 1 ,Giulia Ruffinazzi 1, Armando D Angelo 2, Nunzia Decembrino 3, Paolo Manzoni 4, Agata Boncimino 1 and Mauro Stronati 1 1Neonatology and Neonatal Intensive Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia 2Coagulation Sevice & Thrombosis Research Unit, Scientific Institute HS. S. Raffaele Milan 3Neonatal Intensive Care Unit Fondazion e MBBM. standard treatment for serious neonatal infections (ie, septicemia, pneumonia,andmeningitis)indevelopingcountries.10,11 Inresource poor countries, however, the majority of births and neonatal deaths still take place at home, and families often are reluctant to seek care outside the home for neonatal illness for a variety of reasons Sepsis, also known as septicemia, is a toxic condition caused by the spread of invading organisms, or their by-products, through the bloodstream or in other tissue in the body. Nurses are essential in identifying symptoms of sepsis and in the treatment of the neonate with suspected or confirmed infection Recovery from neonatal sepsis depends on the severity and form of the infection. Current survival rates are 55 to 75% in equine intensive care units of large veterinary hospitals. An average of 1 to 4 weeks of intensive care should be expected. Early recognition and intensive treatment of foal sepsis improves the outcome

Fading Puppy Syndrome in Dogs VCA Animal Hospita

  1. There was a seasonal trend, with dogs more likely to have streptococcal infection in summer months. In dogs for which a disease process was identified, streptococcal infection was associated with dermatitis (29 dogs), pneumonia (24 dogs), adult septicemia (13 dogs), and fetal/neonatal septicemia leading to abortion or neonatal death (16 dogs)
  2. Treatment for septicemia and bacteremia in dogs often begins with emergency support, as septicemia can easily be fatal. If a dog is in septic shock, they may need hospitalization with intravenous.
  3. Neonatal Sepsis Chest X-Ray • Persistent focal changes with infiltrative process • Findings similar to RDS in GBS infection 20. Neonatal Sepsis Acute Phase Reactants - Sepsis Screen Positive CRP ( > 6 mg/ L or 10 times normal) Elevated hepatoglobin level Micro ESR After 14 days of age 15 mm or more for the first hour is abnormal
  4. Find the best doctors for Neonatal Sepsis in Nowshera. Book in-person or online video appointments with the help of up to date practice locations, reviews and fees and save upto 50%
  5. ant neonatal pathogen CoNS. 1. Epidemiology of Neonatal Sepsis. Neonatal sepsis is defined as infection in the first 28 days of life, or up to 4 weeks after the expected due date for.
  6. Neonatal Isoerythrolysis Average Cost. From 335 quotes ranging from $500 - $2,00
  7. Treatment of neonatal sepsis with intravenous immune globulin. N Engl J Med. 2011 Sep 29. 365 (13):1201-11. . Centers for Disease Control and Prevention. Prevention of perinatal group B.

As the national incidence of neonatal early-onset sepsis (EOS) has declined over the past 30 years, this infection presents neonatal caregivers with a difficult clinical problem: an infection with low incidence, high consequence and nonspecific clinical manifestations that can be indistinguishable from normal newborn transition or conditions of. Treatment Options for Dogs with Septicemia. The treatment of septic fever should be aggressive, so that the dog can be saved. The dog will have to be hospitalized, as an outpatient treatment may not be sufficient and the dog needs to be monitored and the possible complications should be dealt with immediately. Septicemia is a severe condition. There is an association report of therapy with ranitidine and increased late neonatal sepsis, whose mechanism is still incerto [22]. TRANSMISSION . The environment of the newborn is of great importance in the transmission of disease, since this will be colonized by germs existing there Importance Early-onset sepsis (EOS) remains a potentially fatal newborn condition. Ongoing surveillance is critical to optimize prevention and treatment strategies. Objective To describe the current incidence, microbiology, morbidity, and mortality of EOS among a cohort of term and preterm infants

Jiang, Progress in diagnosis and treatment of neonatal septicemia, Chin JNeonatol, vol. The Analysis of Etiology and Risk Factors for 192 Cases of Neonatal Sepsis Neonatal septicemia is a serious illness but curable if identified early Neonatal listeriosis is acquired transplacentally or during or after delivery. Symptoms are those of sepsis. Diagnosis is by culture or polymerase chain reaction testing of mother and infant. Treatment is antibiotics, initially ampicillin plus an aminoglycoside. (See also Listeriosis in adults and Overview of Neonatal Infections .

Antibiotic regimens for neonatal sepsis - a protocol for a

Incidence, Diagnosis and treatment of Neonatal Sepsis - A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 1c834c-ZDc1 Neonatal sepsis. Neonatal sepsis is a systemic infection occurring in infants at less than 28 days of life and is an important cause of morbidity and mortality of newborns 1).Sepsis is a life-threatening medical emergency that happens when your baby has an overwhelming immune response to a bacterial infection Case of neonatal septicemia and partial failure of passive transfer of antibodies in 1,5 day old foal, filly is described below. Enterocolitis, pneumonia and localized infection of right tarsal joint and omphaloarteritis developed as complications of the foal's status. E. coli was identified as a causative organism of septicemia. The foal was treated by combination of antibiotic administration.. In addition, transient neonatal diabetes mellitus is a rare self-limited cause that usually occurs in small-for-gestational-age infants; corticosteroid therapy may also result in transient hyperglycemia. Hyperglycemia is less common than hypoglycemia, but it is important because it increases morbidity and mortality of the underlying causes Neonatal septicemia and meningitis are the most common Citrobacter infections in infants and children. 6-9 Septicemia is associated with meningitis in about half of cases. From 1969 to 1989 in Dallas, Citrobacter spp. accounted for 9% of 91 cases of gram-negative enteric meningitis in infants aged 1 day to 2 years. 14 C. koseri was.

Septicemia is a bacterial infection spread through the entire vascular system of the body. Untreated it can result in sepsis, a life-threatening inflammation. There is treatment for septicemia. How CDC is leading the way to improve sepsis outcomes. Clinical Information. Guidelines, educational resources, tools for healthcare professionals, and statistical reports on sepsis incidence, prevalence, and mortality. Educational Information. For patients, healthcare professionals, partners, and Spanish speakers

NEONATAL SEPSIS and OTHER INFECTIONS. Definitions. Sepsis is defined as isolation of bacteria or other pathogenic organism from the blood of a baby with clinical signs. Proven sepsis in term infants is not common (1-2 per 1000 or 0.1%), but the diagnosis of suspected or clinical sepsis is made frequently Treatment of neonatal sepsis. Early and aggressive treatment with antimicrobials within an hour of diagnosing suspected sepsis, with immediate adequate fluid resuscitation, and monitoring as. Neonates hospitalised within 72h of life and requiring empirical antibacterial treatment for early onset neonatal sepsis. Criteria. Inclusion Criteria: All neonates, admitted to the study NICU-s at the age of less than 72 hours and needing early empiric antibiotic treatment according to pre-defined criteria as described by Schrag et al. (2002 Treatment of neonatal sepsis is aimed at treating the underlying infectious cause of sepsis [45, 46], and cor-recting the associated organic dysfunction through, e.g. respiratory support, circulatory support and correction of metabolic, temperature and glucose derangements [47, 48]. This review assesses the first part, which is t

FADING PUPPY SYNDROME and/or SEPSIS - Mastiff Message Boar

  1. istered and repeated after 4
  2. 1 Background Neonatal infections, including sepsis, comprise an estimated 26% to 36% of the neonatal deaths that occur globally in low- to middle-income countries.2,3 Approximately 400,000 newborns die each year from sepsis primarily in low-resource settings.4 Current World Health Organization (WHO) guidelines for treatment of neonatal sepsis of unknown etiology include hospitalization and 7.
  3. Neonatal deaths account for 44% of all deaths under the age of 5 years, and three-quarters of these neonatal deaths occur in developing countries. 1 Infections are thought to account for around one-third of neonatal deaths, 1 but the consequences of neonatal infection extend beyond mortality, to long-term neurodevelopmental impairment in survivors. 2 Improving recognition of neonatal sepsis.
  4. works (VON) as sepsis with onset within 72 hours of birth • late onset sepsis—sepsis occurring after 3 days of age in a NICU patient and after 7 days of age in a term infant. The incidence of early-onset sepsis is 0.77-1 per 1,000 live births. According to the National Institute of Child Health & Human Development (NICHD) Neonatal.

Treatment of canine sepsis: First identify, eradicate the

  1. Early-onset sepsis is seen in the first week of life. Late-onset sepsis occurs between days 8 and 89. Causes. A number of different bacteria, including Escherichia coli (E.coli), Listeria, and certain strains of streptococcus, may cause neonatal sepsis. Early-onset neonatal sepsis most often appears within 24 hours of birth
  2. Treatment of allergies in newborn puppies is inappropriate, because the health risks exceed the likely positive effect. Puppies of allergy sufferers are transferred to another type of food, for example, milk powder of another brand, baby formula for babies or goat's milk, diluted with boiled water
  3. Fading puppy syndrome is a term used to describe a puppy dying for unknown reasons shortly after it is born, with no clinical signs, or any clear cause of death. This syndrome, also known as failure to thrive, might happen anytime during the first week or even after ten weeks. Breeders and dog owners would do anything to take care of their.
  4. Early-onset sepsis (EOS) remains a serious and often fatal illness among infants born preterm, particularly among newborn infants of the lowest gestational age. Currently, most preterm infants with very low birth weight are treated empirically with antibiotics for risk of EOS, often for prolonged periods, in the absence of a culture-confirmed infection
  5. General treatment of septicemia in neonatal calves. Neonatal septicemia is a critical condition with a high mortality. Treatment goals aim to (1) control the infection, (2) modulate the inflammatory response, and (3) support the animal during the critical phase. Appropriate cultures should be obtained if judged necessary

Colisepticemia - Generalized Conditions - Merck Veterinary

Coccidia is a microscopic parasite that invades puppies' intestinal lining. Common symptoms of infection might include watery or bloody diarrhea, vomiting, and weakness. Treatment for Coccidia in puppies is straightforward and requires medication. If the infection is caught on time and treated properly, the prognosis is generally good Sepsis can be life threatening as the infection can affect several body systems at the same time. This can make providing treatment more difficult. Babies with sepsis will require care in the newborn intensive care unit (NICU), and may need antibiotics, other medications, and specialized treatment (such as a mechanical breathing machine)

Pediatric Critical Care - Veterinary Medicine at Illinoi

Juvenile Cellulitis (Puppy Strangles) This is a condition that causes the face, nose, eyelids or lips to swell and sometimes form ulcers. The ulcers or abscesses can break open, drain and cause a secondary bacterial infection. Per Doctors Foster and Smith, treatment is 3-4 weeks consisting of high doses of corticosteroid Neonatal sepsis is the cause of substantial morbidity and mortality. Precise estimates of neonatal sepsis burden vary by setting. Differing estimates of disease burden have been reported from high-income countries compared with reports from low-income and middle-income countries. The clinical manifestations range from subclinical infection to. Survivors of neonatal sepsis may suffer short- and long-term consequences (28, 29).Delayed recognition and therapy of sepsis increase the risk of morbidity and mortality and early antibiotic treatment of suspected sepsis is a corner stone of every sepsis care bundle ().Therefore, clinicians have a low threshold to suspect neonatal EONS and to start empirical antibiotic therapy Neonatal sepsis is associated with increased mortality and morbidity including neurodevelopmental impairment and prolonged hospital stay. Signs and symptoms of sepsis are nonspecific, and empiric antimicrobial therapy is promptly initiated after obtaining appropriate cultures. However, many preterm and low birth weight infants who do not have infection receive antimicrobial agents during. Twelve years ago an annotation was published in Archives of Disease in Childhood regarding the antibiotic treatment of suspected neonatal meningitis. The authors recommended the use of cephalosporins rather than chloramphenicol and advocated intraventricular aminoglycoside treatment in selected cases. They noted the absence of clinical trials with third generation cephalosporins that showed an.

RISK FACTORS LINKED TO PUPPIES - Neonatal Disorder

Neonatal sepsis is one of the leading causes of neonatal morbidity and mortality. Despite implementing of different preventive interventions, the burden of neonatal sepsis is reporting in different areas of Ethiopia. For further interventions, identifying its determinants is found to be crucial. This study aimed to identify determinants of neonatal sepsis in the Northwest part of Ethiopia Sepsis in the Newborn 1. Introduction Sepsis is the commonest cause of neonatal mortality and is probably responsible for 30-50% of the total neonatal deaths each year in developing countries1,2. It is estimated that 20% of all neonates develop sepsis and approximately 1% die of sepsis related causes2 Meta-analyses of the effectiveness of intravenous immune globulin for prevention and treatment of neonatal sepsis. Pediatrics 1997;99(2):E2. CAS PubMed Google Scholar 40. Ohlsson A, Lacy JB .. Neonatal Sepsis. Neonatal sepsis is an infection in the bloodstream that poses severe health risks to newborns, including permanent brain damage.It can be caused by a variety of bacteria, viruses, and other pathogens. A baby can acquire neonatal sepsis through either vertical or horizontal transmission Neonatal sepsis occurs in 0.5 to 8.0/1000 births. The highest rates occur in. Low-birth-weight (LBW) infants. Infants with depressed function at birth as manifested by a low Apgar score. Infants with maternal perinatal risk factors (eg, low socioeconomic status, premature rupture of membranes) Minorities. Males

Sepsis in Dogs - SEPTICEMINA - Symptoms, Treatment And

Neonatal sepsis is known as the most common cause of death in newborn infants, with the incidence of 6.5-38 among 1000 live births [1,2,3].The combined rate of major morbidity and mortality of sepsis is up to 10-20% for all infants and 20-30% for very low birth weight infants [4,5,6].Preterm infants with Gram-negative septic shock have the death rate of 65-85% despite of broad-spectrum. treatment of neonatal sepsis. Resistant pathogens have been found all over the world in urban and . rural areas in both high- and low-income countries and the number of . antibiotics that no longer work for many of these pathogens is growing. This is reflected in the survey, where 79% of physicians report seeing an. If diagnosed in time, and treated correctly, the baby will make a full and complete recovery from neonatal sepsis. However in cases of septic shock, the survival rate is less than fifty percent Neonatal sepsis is one of the major causes of death during the first month of life and early empirical treatment with injectable antibiotics is a life-saving intervention. Adherence to World Health Organisation guidelines on first line antibiotics is crucial to mitigate the risks of increased antimicrobial resistance. The aim of this paper was to evaluate if treatment of early onset neonatal.

Treatment involves early aggressive treatment in the hospital for the early stages of sepsis, starting them off on antibiotics even before the diagnosis is confirmed, then moving on to blood pressure medicines and IV fluids if the situation calls for it. 8. Influenza. Influenza is contagious and can be spread from person to person Antibiotic regimens for suspected late onset sepsis in newborn infants. The Cochrane database of systematic reviews. 2005(3):CD004501. Lopez Sastre JB, Fernandez Colomer B, Coto Cotallo GD, Ramos Aparicio A, Grupo de Hospitales C. Trends in the epidemiology of neonatal sepsis of vertical transmission in the era of group B streptococcal prevention Neonatal sepsis differs from adult sepsis in terms of symptoms, diagnosis and treatment, and continues to have a high rate of morbidity and mortality for infants. Neonatal sepsis occurs within the first 30 days of life, although some late-onset sepsis has been described within the first 90 days of life, particularly whe