Sepsis in the Newborn
Sepsis is bacterial infection in the blood.
Newborns with sepsis are listless, do not feed well, and often have a low body temperature.
The diagnosis is based on symptoms and the presence of bacteria in the blood.
Most newborns who recover from sepsis do not have long-term problems.
Treatment involves antibiotics, fluids given by vein (intravenously), and sometimes a ventilator to support breathing and drugs to support blood pressure.
Premature infants are at much higher risk of both early-onset and late-onset sepsis than are infants born at full term because of their immature immune system. Premature newborns lack certain antibodies against specific bacteria because these antibodies do not cross the placenta from the mother into the fetus’s blood until late in pregnancy.
Other risk factors for and causes of sepsis differ depending on whether sepsis develops in the first few days of life (early-onset sepsis) or 7 days or more after birth (late-onset sepsis).
Risk factors include the following:
The risk of sepsis is greater if the fluid-filled membranes that surround the fetus rupture more than 18 hours before birth or if the mother has an infection (particularly of the urinary tract or lining of the uterus).
The most common types of bacteria causing sepsis in the newborn around the time of birth are Escherichia coli and GBS, which are usually acquired during passage through the birth canal. Sepsis caused by GBS was the leading cause of early-onset sepsis until about a decade ago when screening of all expectant mothers for GBS became a routine part of prenatal care. If screening reveals GBS, the mother is given antibiotics when she goes into labor. The newborn, if delivered vaginally, is immediately given antibiotics.
Important risk factors include the following:
Sepsis that occurs later is more likely to be acquired from unwashed hands or the environment and may be caused by various organisms.
Some Infections of Newborns
Newborns with sepsis are usually listless, do not feed well, and often have a low body temperature. Other symptoms may include pauses in breathing (apnea), fever, pale color, and poor skin circulation, with cool extremities, abdominal swelling, vomiting, diarrhea, seizures, jitteriness, and jaundice. The diagnosis is suggested by the newborn’s symptoms and the results of a complete blood count. A definite diagnosis is made only if bacteria are identified in a culture of the newborn’s blood.
One of the most serious complications of sepsis is infection of the membranes surrounding the brain (meningitis). Newborns with meningitis may have extreme sluggishness (lethargy), coma, seizures, or bulging of the soft spot between the skull bones (fontanelle). Doctors can diagnose meningitis by doing a spinal tap (lumbar puncture), examining the cerebrospinal fluid, and culturing a sample of this fluid.
Sepsis is the major cause of death in premature newborns after the first week. Newborns who recover from sepsis should not have long-term problems, except those with meningitis, who may have developmental delay, cerebral palsy, seizures, or hearing loss.
While awaiting blood culture results, doctors give intravenous antibiotics to newborns with suspected sepsis. Once the specific organism has been identified, the type of antibiotic can be adjusted. In addition to antibiotic therapy, other treatments may be needed, such as use of a ventilator, intravenous fluids, and support of blood pressure and circulation.