What is a Neonatal Sepsis?
Neonatal sepsis is a potentially life-threatening blood infection in a neonate (a newborn child) or an infant of less than 3 months old that can cause serious health risks, including permanent brain damage. Neonatal sepsis can be differentiated into early-onset sepsis and late-onset sepsis. Early-onset sepsis occurs in the first week of a baby’s life. Late-onset sepsis occurs after the first week through three months of age.
Neonatal sepsis is one of the leading causes of morbidity and mortality. It is estimated that up to twenty percent of neonates develop sepsis and approximately one percent die of sepsis-associated causes. Neonatal sepsis-related mortality can be averted substantially with prevention of sepsis itself by timely detection, aggressive supportive care, and rational antimicrobial treatment.
Causes of Neonatal Sepsis
Neonatal sepsis is most commonly caused by bacterial infections with Group B streptococcus (GBS) bacteria being a major cause of neonatal sepsis. The condition can also be caused by parasites, fungal or viral infections such as herpes simplex virus (HSV) which can cause serious infection in a neonate. Normally, the baby contracts infection from the mother either before delivery or at the time of birth or after birth in the hospital environment as a hospital-acquired infection. Neonatal sepsis most often presents with pneumonia and/or septicemia.
Risk Factors for Neonatal Sepsis
Some of the factors that could increase an infant’s risk of developing neonatal sepsis include:
- Low birth weight
- Male babies
- Exposure to GSB bacteria during pregnancy
- Premature birth
- Infection of the amniotic fluid (chorioamnionitis) and placenta
- Early water breaking or rupture of the amniotic sac (more than 18 hours before birth)
- Colonization of the mother’s birth canal with bacteria
- Exposure to organisms after birth in the hospital setting
- Use of intravascular catheters or endotracheal tubes in babies requiring early care
- Prolonged hospitalization
Signs and Symptoms of Neonatal Sepsis
Signs and symptoms of neonatal sepsis may include:
- Fever
- Low blood sugar
- Decreased movements
- Poor sucking
- Fluctuations in heart rate
- Decreased bowel movements
- Diarrhea
- Breathing issues
- Vomiting
- Swollen abdomen
- Jaundice
- Seizures
- Irritability or fussiness
- Lack of energy
Diagnosis of Neonatal Sepsis
In order to diagnose neonatal sepsis and identify the cause of infection, your physician may conduct the following tests:
- Blood tests including blood cultures, C-reactive protein, and complete blood count (CBC)
- A spinal tap or lumbar puncture to check for bacteria in the spinal fluid
- Urine, stool, and skin cultures to check for the presence of herpes virus
- Chest X-ray if the infant has cough or breathing issues
Treatment for Neonatal Sepsis
Treatment for neonatal sepsis may include the following:
- Intravenous (IV) antibiotic treatment for neonates younger than 4 weeks old for symptoms of fever or other signs of infection. Mothers who have chorioamnionitis or at high risk of developing it for other reasons will also undergo IV antibiotics treatment.
- Supportive care such as intravenous fluid therapy (IVT) to restore fluid level in a severely dehydrated child due to diarrhea or vomiting.
- Use of antiviral medications such as acyclovir for the treatment of infections caused by HSV.
- Nutritional support through nasogastric (NG) tube for infants who are too sick to feed.
- Administration of intravenous medications to maintain blood pressure, heart function, and restore other vital signs.
- Oxygen or other forms of respiratory support to correct breathing issues and restore blood oxygen level.
Prevention of Neonatal Sepsis
Neonatal sepsis can be prevented by treating the expectant mother with IV antibiotics for several hours prior to delivery. This should be done for mothers who have or at risk of developing chorioamnionitis, GBS bacteria colonization, or have delivered a child previously with sepsis. Other things that can help prevent sepsis include providing a clean environment for birth, giving birth within 12 to 24 hours of water breakage, and preventing/treating infections in mothers, including HSV.
Complications of Neonatal Sepsis
Possible complications of neonatal sepsis may include:
- Neonatal seizures
- Septic shock
- Bradycardia/apnea
- Feeding issues
- Respiratory distress
- Meningitis (infection of the brain and spinal cord tissue)
- Encephalitis (swelling and irritation of the brain tissue)
