Neonatal sepsis

Answer 1

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; Sepsis - infant

Causes, incidence, and risk factors

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. 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 (group b strep) 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)

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

• 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
• Complete blood count (CBC)

A lumbar puncture (spinal tap) will be done to examine the cerebrospinal fluid for bacteria.

If the baby has a cough or problems breathing, a chest x-ray will be taken.

Urine culture tests are done in babies older than several days.

Treatment

Babies in the hospital and those younger than 4 weeks old are started on antibiotics before lab results are back. (Lab results may take 24-72 hours.) This practice has saved many lives.

Older babies may not be given antibiotics if all lab results are within normal limits. Instead, the child may be followed closely on an outpatient basis.

Babies who do require treatment will be admitted to the hospital for monitoring.

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.

Answer 2

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; Sepsis - infant

Causes, incidence, and risk factors

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. 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
• Water breaking (rupture of membranes) that lasts longer than 24 hours before birth
• Infection of the placenta tissues and amniotic fluid (chorioamnionitis)

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

• 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
• Complete blood count (CBC)

A lumbar puncture (spinal tap) will be done to examine the cerebrospinal fluid for bacteria.

If the baby has a cough or problems breathing, a chest x-ray will be taken.

Urine culture tests are done in babies older than several days.

Treatment

Babies in the hospital and those younger than 4 weeks old are started on antibiotics before lab results are back. (Lab results may take 24-72 hours.) This practice has saved many lives.

Older babies may not be given antibiotics if all lab results are within normal limits. Instead, the child may be followed closely on an outpatient basis.

Babies who do require treatment will be admitted to the hospital for monitoring.

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 chorioamnionitis, Group B strep, 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

Verani JR, McGee L, Schrag S. Prevention of Perinatal Group B Streptococcal Disease, Revised Guidelines from CDC, 2010. Morbidity and Mortality Weekly Report. 59(RR-10): 1-36, 2010.

Stoll et al . Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues. Pediatrics 2011: 127:817-826.

Reviewed By

Review Date: 05/09/2011

Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.