Neonatal sepsis
Neonatal sepsis is a serious bacterial infection that occurs in infants, typically within the first month of life. It can be categorized into early-onset sepsis, which develops within the first week after birth and is often transmitted from the mother, and late-onset sepsis, which arises after one week and is usually acquired from the caregiving environment. Various factors increase the risk of a newborn developing this condition, including prematurity, low birth weight, and complications during labor. Symptoms of neonatal sepsis can appear rapidly within the first 24 to 48 hours and may include fever, poor feeding, vomiting, and unusual sleepiness, among others. Diagnosis typically involves a physical exam and laboratory tests, including blood cultures. Treatment commonly requires hospitalization and can last from a few days to over three weeks, depending on the severity of the infection. Preventative measures, such as administering antibiotics to mothers at risk and promoting breastfeeding, can help reduce the incidence of neonatal sepsis, which is more prevalent in developing countries due to inadequate healthcare resources. Awareness of symptoms and timely medical intervention are crucial for improving outcomes in affected infants.
Neonatal sepsis
- ANATOMY OR SYSTEM AFFECTED: Blood, reproductive system
Definition
Neonatal sepsis, a bacterial infection in the blood that may become a serious condition, is sometimes found in infants during the first month of life.
Causes
Neonatal sepsis is caused when the fetus or baby is exposed to bacteria. Early-onset sepsis that develops within the first week of birth comes from the pregnant woman (through the placenta or from passing through the birth canal). Late-onset sepsis that develops one week after birth comes from the caregiving environment. Intrapartum antibiotics have prevented early-onset bacterial sepsis.
Some factors related to a woman’s pregnancy or health also add to the chance that the fetus or newborn can get this condition. These factors include labor complications resulting in traumatic or premature delivery, the breaking of the woman’s “water” more than eighteen hours before giving birth, a fever or other infection while in labor, and the long-term need for a catheter while pregnant.
Risk Factors
In addition to the foregoing risk factors, the following increase a fetus’s or a newborn’s chance of developing neonatal sepsis: the baby is born more than three weeks before the due date (it is premature); the woman goes into labor more than three weeks before the due date; the fetus is in distress before being born; the newborn has a low birth weight; the fetus has a bowel movement before being born, and the uterus contains fetal stool; and the amniotic fluid that surrounds the baby has a bad smell, or the baby has a bad smell at birth. Newborn boys are at greater risk for neonatal sepsis than newborn girls.
Symptoms
In most cases, symptoms are present within twenty-four hours of birth. In almost all cases, they will be present within forty-eight hours of birth. The following symptoms are not necessarily caused by neonatal sepsis; other, less serious health conditions may cause them. However, one should consult a doctor if the baby displays any of the following: fever or frequent temperature changes; poor feeding from breast or bottle; decreased or absent urination or a bloated abdomen; vomiting of yellowish material; diarrhea; extreme redness around the belly button; skin rashes; unexplained high or low blood sugar; difficulty waking or unusual sleepiness; jaundiced or overly pale skin; abnormally slow or fast heartbeat; rapid breathing; difficult breathing; periods of no breathing (apnea); bruising or bleeding; seizures; and cool, clammy skin.
Screening and Diagnosis
A doctor will ask about the baby’s symptoms and medical history and perform a physical exam. Tests may include a complete blood count, cultures of the blood, urine, cerebrospinal fluid, and skin lesions, and X-rays of the chest or abdomen.
Treatment and Therapy
Consult the doctor about the best treatment plan. Treatment depends on the severity of the condition and may last two to twenty-one days. In general, neonates suspected of having sepsis are hospitalized for a minimum of two days to wait for culture results. A well-appearing infant may be monitored without antibiotics. The infant is sent home when cultures are negative. Culture-proven sepsis is treated for seven to twenty-one days, depending on the location of the infection.
The baby may also need intravenous antibiotic medication, fluids, glucose, electrolytes, or oxygen to help with ventilation (breathing). The rise in antibiotic-resistant infections has increased concern for cases of neonatal sepsis due to antimicrobial resistance.
Prevention and Outcomes
To reduce the chance that a fetus or newborn will get neonatal sepsis, the doctor may prescribe antibiotics near the due date for women who have given birth to a baby with neonatal sepsis. The antibiotics will kill dangerous bacteria in the birth canal. The doctor may also test the woman for bacteria before the due date and prescribe antibiotics, and they may recommend breastfeeding, which can help prevent sepsis in some infants. Newborns in developing nations are more likely to get neonatal sepsis because of poor sanitation, lack of access to healthcare for mother and baby, and environmental factors.
Bibliography
Behrman, Richard E., Robert M. Kliegman, and Hal B. Jenson, eds. Nelson Textbook of Pediatrics. 18th ed., Philadelphia: Saunders/Elsevier, 2007.
Herbst, A., and K. Källén. "Time Between Membrane Rupture and Delivery and Septicemia in Term Neonates." Obstetrics and Gynecology, vol. 110, no. 3, Sept. 2007, pp. 612-618.
Martin, Richard J., Avroy A. Fanaroff, and Michele C. Walsh, editors. Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 2 vols. 8th ed., Philadelphia: Mosby/Elsevier, 2006.
Merenstein, Gerald B., and Sandra L. Gardner, editors. Merenstein and Gardner’s Handbook of Neonatal Intensive Care. 7th ed., Maryland Heights, Mo.: Mosby/Elsevier, 2011.
"Neonatal Sepsis." MedlinePlus, 25 Apr. 2023, medlineplus.gov/ency/article/007303.htm. Accessed 27 Sept. 2024.
Niyoyita, Jean C., et al. "Factors Associated with Neonatal Sepsis among Neonates Admitted in Kibungo Referral Hospital, Rwanda." Scientific Reports, vol. 14, no. 1, 2024, pp. 1-9, doi.org/10.1038/s41598-024-66818-z. Accessed 27 Sept. 2024.