Neonatal sepsis

Definition

Neonatal sepsis is a blood infection that occurs in an infant younger than 90 days old. Early-onset sepsis is seen in the first week of life. Late-onset sepsis occurs between days 8 and 89.

Alternative Names

Sepsis neonatorum; Neonatal septicemia

Causes, incidence, and risk factors

A number of different bacteria, including E.coli, Listeria, and certain strains of Streptococcus, may cause neonatal sepsis.

Early-onset neonatal sepsis most often appears within 24 hours of birth. The baby gets the infection from the mother before or during delivery. The following increases an infant's risk of early-onset sepsis:

• Group B Streptococcus infection during pregnancy
• Preterm delivery
• Rupture of membranes (placenta tissue) that lasts longer than 24 hours
• Infection of the placenta tissues and amniotic fluid (chorioamnionitis)
• Frequent vaginal examinations during labor

Babies with late-onset neonatal sepsis get infected after delivery. The following increase an infant's risk of sepsis after delivery:

• Contaminated hospital equipment
• Exposure to medicines that lead to antibiotic resistance
• Having a catheter in a blood vessel for a long time
• Staying in the hospital for an extended period of time

Symptoms

Infants with neonatal sepsis may have the following symptoms:

• Body temperature changes
• Breathing problems
• Diarrhea
• Low blood sugar
• Reduced movements
• Reduced sucking
• Seizures
• Slow heart rate
• Swollen belly area
• Vomiting
• Yellow skin and whites of the eyes (jaundice)

Signs and tests

Laboratory tests can help diagnose neonatal sepsis and identify the bacteria that is causing the infection. Blood tests may include:

• Blood culture
• C-reactive protein
• White blood cell count

If a bacterial infection is strongly suspected, other tests may include lumbar puncture, urine tests, and chest x-rays.

Treatment

Antibiotics are given to kill the bacteria. If the baby is septic and gravely ill, intravenous immune globulin may be given.

Because early treatment is so valuable, often doctors will ordering lab tests and start treatment before the results are even back. This practice has saved many lives.

Expectations (prognosis)

With prompt treatment, many babies with these bacterial infections will recover completely with no remaining problems. Nevertheless, neonatal sepsis is a leading cause of infant death. The more quickly an infant receives treatment, the better the outcome.

Complications

• Disability
• Death

Calling your health care provider

Seek immediate medical help if your infant shows symptoms of neonatal sepsis.

Prevention

Preventative antibiotics may be given to pregnant women who have a Group B Streptococcus infection or who have previously given birth to an infant with sepsis due to the bacteria.

Preventing and treating infections in mothers, providing a clean birth environment, and delivering the baby within 24 hours of rupture of membranes, where possible, can all help lower the chance of neonatal sepsis.

References

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. London: Churchill Livingstone; 2005.

Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group B streptococcal disease. Morbidity and Mortality Weekly Report. 51(RR-11): 1–22, 2002.

Schrag S. Prevention of neonatal sepsis. Clin Perinatol. Sept 2005; 32(3): 601-15.