Neonatal Sepsis (Sepsis In Newborn)
Neonatal Sepsis is a life threatening illness caused by bacterial infections occurring in the blood or elsewhere in the body.
- Poor feeding, lower than normal body temperature, and lethargy are the usual symptoms of sepsis.
- The typical symptoms may indicate the condition, but a blood test which detects the bacterial infection in the blood confirms the diagnosis.
- Infants with sepsis may recover completely with appropriate treatment, and usually suffer no lasting consequences.
- Antibiotic therapy and fluid supplementation are intravenously administered. Drugs may be required to maintain blood pressure, and ventilator support may be necessary to aid breathing.
Infants born prematurely are at a higher risk of developing neonatal sepsis than those who are born on completing full term. One reason is that the immune system of the premature babies is not yet fully mature. The other reason is that premature babies lack antibodies which would protect them from various infective organisms, because the mother’s antibodies usually pass through the placenta into the fetus only towards the end of pregnancy.
Sepsis in newborn is differentiated into early-onset and late-onset sepsis based on the time of occurrence of this condition. When the symptoms develop in the very first week of life, it is termed early–onset sepsis and when they appear later than seven days, it is considered as late-onset sepsis. The treatment for both the categories is same, but the causes differ.
Early-Onset Neonatal Sepsis:
The sepsis developing in newborns in the first week usually have the following risk-factors:
- Infections present in the mother affecting the fetus prior to birth or at the time of birth.
- Early rupture of the amniotic sac that encloses the fetus, resulting in prolonged exposure to infective organisms.
- The mother having Group B Streptococcus infection.
Infections of the uterine lining and the urinary tract of the mother may get passed on to the fetus. When the fluid-filled amniotic sac which protects the fetus ruptures much before the onset of labor, the fetus gets exposed to various microorganisms which can cause infections that may lead to sepsis. Escherichia coli and Group B Streptococcus (GBS) are the two usual infective agents causing sepsis in newborns when they are present in the mother. In fact, GBS infection contracted by newborns used to be the major cause of early-onset sepsis till routine screening of the mother for the presence of GBS infection became common. An infected mother is treated with antibiotics at the time of labor, and the infant is also given antibiotic therapy if it has a vaginal delivery.
Late-Onset Neonatal Sepsis:
The infant may develop sepsis seven days or more after birth due to the following reasons:
- Hospitalization of the infant for prolonged periods.
- Catheters inserted into the arteries and veins for various treatment procedures.
- Using endotracheal tube introduced through the mouth or nose of the infant to provide ventilator support.
Exposure to various microorganisms in the hospital, and direct introduction of infections through catheterization and intubation for treatment procedures, and handling the infant with unclean hands, increase the likelihood of the newborn developing sepsis.
Symptoms and Diagnosis
When infants have sepsis, they become lethargic, and usually have a lower body temperature known as hypothermia. Sometimes fever may be present. Feeding becomes poor. Diarrhea and vomiting may be present along with abdominal distension. The skin may be yellowish due to jaundice, or pale because of poor circulation. The extremities feel cold to touch too. Breathing problems such as short breaks in breathing called apnea, and seizures may occur. When the symptoms are present, a blood test to determine the blood count may confirm sepsis, but a culture result identifying the causative agent is a more definitive test.
Meningitis or the infections affecting the membranes enclosing the brain is an extremely dangerous complication precipitated by sepsis. Extreme lethargy, seizures and coma are the usual symptoms of meningitis. The fontanelle or soft spot on the top of the head in infants usually bulges out. When meningitis is suspected, a lumbar puncture is done to draw out a sample of the cerebrospinal fluid for culture study.
Prognosis and Treatment
Premature infants are more prone to neonatal sepsis than term babies and this illness kills more premature babies entering the second week of their life than any other disorder. Most infants who survive the illness recover completely without any long term ill effects. However, infants who had meningitis may have certain lasting consequences like hearing loss, developmental delay, seizures or even cerebral palsy.
The blood is cultured to identify the exact organism that is causing the sepsis so that specific antibiotics against it can be used to treat the infection. However, the doctors usually start antibiotic therapy with wide-spectrum antibiotics even before the results arrive, as any delay can be dangerous. Once the culture report comes, the medications are adjusted accordingly. Fluids are also given intravenously. Infants requiring assistance with breathing are given ventilator support. They are given drugs to keep the blood pressure steady, if required.
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Yasser Elnahas
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