Newborns with sepsis appear generally ill—they are listless, do not feed well, often have a gray color, and may have a fever or a low body temperature.
The diagnosis is based on the symptoms and the presence of bacteria, a virus, or a fungus in the blood, urine, or spinal fluid.
Treatment involves antibiotics and supportive treatments such as intravenous fluids, blood and plasma transfusions, assistance with breathing (sometimes with a mechanical ventilator), and drugs to support blood pressure.
Infection in the bloodstream may spread to the tissues covering the brain and the brain itself (meningitis).
(See also Overview of Infections in Newborns Overview of Infections in Newborns Infections occur at all ages but are a great cause for concern in newborns because newborns, especially premature ones, have an underdeveloped immune system and are more susceptible to infection... read more and Sepsis, Severe Sepsis, and Septic Shock Sepsis and Septic Shock Sepsis is a serious bodywide response to bacteremia or another infection plus malfunction or failure of an essential system in the body. Septic shock is life-threatening low blood pressure ... read more .)
Sepsis is more likely to occur in
Infants who have a low birth weight
Infants whose mother has certain risk factors (such as a low socioeconomic status or premature rupture of the membranes Prelabor Rupture of the Membranes (PROM) Prelabor rupture of the membranes is the leaking of amniotic fluid from around the fetus at any time before labor starts. After the membranes rupture, labor often soon follows. If labor does... read more )
Other risk factors for and causes of sepsis differ depending on when sepsis develops. The start (onset) is categorized as
Early-onset sepsis: Before 3 days of life
Late-onset sepsis: After 3 days or more of life
Certain viral infections, such as widespread herpes simplex Herpes Simplex Virus (HSV) Infections Herpes simplex virus infection causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips (cold sores), eyes, or genitals. This very contagious viral infection... read more , enterovirus Overview of Enterovirus Infections Enterovirus infections affect many parts of the body and may be caused by any of several different strains of enterovirus. Enterovirus infections are caused by many different viruses. Symptoms... read more , adenovirus, or respiratory syncytial virus Respiratory Syncytial Virus (RSV) Infection and Human Metapneumovirus Infection Respiratory syncytial virus infection and human metapneumovirus infection cause upper and sometimes lower respiratory tract infections. Respiratory syncytial virus is a very common cause of... read more , may cause early-onset or late-onset sepsis.
Premature infants Premature Newborn A premature newborn is a baby delivered before 37 weeks of gestation. Depending on when they are born, premature newborns have underdeveloped organs, which may not be ready to function outside... read more 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 protective antibodies against specific bacteria because they were born before they could receive them from their mother.
Newborns can develop early-onset sepsis if they are exposed to certain kinds of bacteria during birth.
Risk factors for early-onset sepsis include the following:
Premature prolonged rupture of the fluid-filled membranes Prelabor Rupture of the Membranes (PROM) Prelabor rupture of the membranes is the leaking of amniotic fluid from around the fetus at any time before labor starts. After the membranes rupture, labor often soon follows. If labor does... read more that surround the fetus
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 or if the mother previously gave birth to a newborn who had a GBS infection, the mother is given antibiotics when she goes into labor. Although the newborn may require additional monitoring in the hospital and possibly blood tests to check for infection, newborns are given antibiotics only if they have symptoms or signs of infection.
Newborns can develop late-onset sepsis if they are exposed to certain kinds of bacteria in the hospital.
Important risk factors for late-onset sepsis include the following:
Prolonged use of catheters in arteries, veins, and/or bladder
Antibiotic use in the newborn
Use of a breathing tube inserted through the newborn's nose or mouth (endotracheal tube) and attached to a machine that helps air get in and out of the lungs ( ventilator Mechanical Ventilation Mechanical ventilation is use of a machine to aid the movement of air into and out of the lungs. Some people with respiratory failure need a mechanical ventilator (a machine that helps air get... read more ) to help support breathing
Sepsis that occurs later is more likely to be acquired from organisms in the newborn's environment, including through or around catheters (a tube doctors use to get fluids or drugs into the newborn's bloodstream, such as an IV, or a tube used to drain urine from the newborn's bladder) and other medical equipment, rather than organisms acquired from the birth canal. The use of certain antibiotics can allow certain organisms such as the fungus Candida to cause infections in the newborn.
Symptoms of Sepsis in Newborns
Newborns with sepsis are usually listless, do not feed well, and often have an unstable body temperature. A fever that lasts for more than an hour is uncommon, but, when present, typically indicates the newborn has an infection.
Other symptoms may include trouble breathing (respiratory distress), pauses in breathing (apnea), pale color, and poor skin circulation, with cool extremities, abdominal swelling, vomiting, diarrhea, seizures, jitteriness, and jaundice Jaundice in the Newborn Jaundice is a yellow color to the skin and/or eyes caused by an increase in bilirubin in the bloodstream. Bilirubin is a yellow substance formed when hemoglobin (the part of red blood cells... read more . Group B streptococcus infection may cause pneumonia Overview of Pneumonia Pneumonia is an infection of the small air sacs of the lungs (alveoli) and the tissues around them. Pneumonia is one of the most common causes of death worldwide. Often, pneumonia is the final... read more . Other symptoms occur depending on which organism is causing the infection.
One of the most serious complications of sepsis is infection of the membranes surrounding the brain (meningitis). Newborns with meningitis Bacterial Meningitis in Newborns Bacterial meningitis is inflammation of the layers of tissue surrounding the brain and spinal cord (meninges) caused by bacteria. Newborns with bacterial meningitis are usually irritable, vomit... read more may have extreme sluggishness (lethargy), coma, seizures Seizures in Children Seizures are a periodic disturbance of the brain’s electrical activity, resulting in some degree of temporary brain dysfunction. When older infants or young children have seizures, they often... read more , or bulging of the soft spot between the skull bones (fontanelle) and often die if not treated promptly.
Diagnosis of Sepsis in Newborns
Cultures of blood and sometimes urine
Spinal tap with culture of the spinal fluid
Doctors diagnose sepsis based on the newborn’s symptoms and the results of tests. Doctors do several tests, including blood tests, to try to determine the specific bacterium, virus, or fungus that is causing the infection.
A blood culture, sometimes a urine culture, and a spinal tap Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography (EEG) is a simple, painless procedure in which... read more (lumbar puncture) are also done. For cultures, doctors take samples of blood, spinal fluid, and urine and try to grow (culture) the bacteria in the samples in the laboratory and identify it. Newborns with breathing problems undergo a chest x-ray.
Prognosis of Sepsis in Newborns
Sepsis is the major cause of death in premature newborns after the first week. Low-birth-weight infants have an increased risk of death. Extremely low-birth-weight infants who have sepsis caused by the fungus Candida or bacteria are at much greater risk of death.
Newborns who recover from sepsis generally do not have long-term problems. However, newborns who survive meningitis may have developmental delay, cerebral palsy Cerebral Palsy (CP) Cerebral palsy refers to a group of symptoms that involve difficulty moving and muscle stiffness (spasticity). It results from brain malformations that occur before birth as the brain is developing... read more , seizures Seizures in Children Seizures are a periodic disturbance of the brain’s electrical activity, resulting in some degree of temporary brain dysfunction. When older infants or young children have seizures, they often... read more , or hearing loss Hearing Impairment in Children Hearing impairment refers to any degree of hearing loss, mild to severe, and can occur when there is a problem with a part of the ear, including the inner, middle, and outer ears, or the nerves... read more .
Treatment of Sepsis in Newborns
Antibiotics by vein (intravenously)
Sometimes a ventilator or other treatments
While awaiting blood culture results, doctors give strong antibiotics intravenously to newborns with suspected sepsis. Once they identify the specific organism, they may adjust the type of antibiotic.
In addition to antibiotic therapy, other treatments may be needed, such as use of a machine that helps with breathing ( mechanical ventilator Mechanical Ventilation Mechanical ventilation is use of a machine to aid the movement of air into and out of the lungs. Some people with respiratory failure need a mechanical ventilator (a machine that helps air get... read more ), intravenous fluids, blood and plasma transfusions, and drugs that support blood pressure and circulation.