Neonatal sepsis

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 after 1 week through 3 months of age.

Causes

Neonatal sepsis can be caused by bacteria such as Escherichia coli (E coli), Listeria, and some strains of streptococcus. Group B streptococcus (GBS) has been a major cause of neonatal sepsis. However, this problem has become less common because women are screened for GBS during pregnancy. The herpes simplex virus (HSV) can also cause a severe infection in a newborn baby. This happens most often when the mother is newly infected with HSV.

Early-onset neonatal sepsis most often appears within 24 to 48 hours of birth. The baby gets the infection from the mother before or during delivery. The following increase an infant's risk of early-onset bacterial sepsis:

• GBS colonization during pregnancy
• Preterm delivery

  Preterm delivery

  A premature infant is a baby born before 37 full weeks of gestation (more than 3 weeks before the due date).

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• Water breaking (rupture of membranes) longer than 18 hours before birth
• Infection of the placenta tissues and amniotic fluid (chorioamnionitis)

Babies with late-onset neonatal sepsis are infected after delivery. The following increase an infant's risk for 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 or decreased bowel movements

  Diarrhea

  Normal baby stools are soft and loose. Newborns have stools often, sometimes with every feeding. For these reasons, you may have trouble knowing wh...

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• Low blood sugar
• Reduced movements
• Reduced sucking
• Seizures

  Seizures

  A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...

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• Slow or fast heart rate

  Slow or fast heart rate

  An arrhythmia is a disorder of the heart rate (pulse) or heart rhythm. The heart can beat too fast (tachycardia), too slow (bradycardia), or irregul...

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• Swollen belly area
• Vomiting
• Yellow skin and whites of the eyes (jaundice)

  Yellow skin and whites of the eyes

  Newborn jaundice occurs when a baby has a high level of bilirubin in the blood. Bilirubin is a yellow substance that the body creates when it replac...

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Exams and Tests

Lab tests can help diagnose neonatal sepsis and identify the cause of the infection. Blood tests may include:

• Blood culture
• C-reactive protein

  C-reactive protein

  C-reactive protein (CRP) is produced by the liver. The level of CRP rises when there is inflammation in the body. It is one of a group of proteins,...

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• Complete blood count (CBC)

  Complete blood count

  A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...

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If a baby has symptoms of sepsis, a lumbar puncture (spinal tap) will be done to look at the spinal fluid for bacteria. Skin, stool, and urine cultures may be done for HSV, especially if the mother has a history of HSV infection.

A chest x-ray will be done if the baby has a cough or problems breathing.

Urine culture tests are done in babies older than a few days.

Treatment

Babies younger than 4 weeks old who have fever or other signs of infection are started on intravenous (IV) antibiotics right away. (It may take 24 to 72 hours to get lab results.) Newborns whose mothers had chorioamnionitis or who may be at high risk for other reasons will also get IV antibiotics at first, even if they have no symptoms.

The baby will get antibiotics for up to 3 weeks if bacteria are found in the blood or spinal fluid. Treatment will be shorter if no bacteria are found.

An antiviral medicine called acyclovir will be used for infections that may be caused by HSV. Older babies who have normal lab results and have only a fever may not be given antibiotics. Instead, the child may be able to leave the hospital and come back for checkups.

Babies who need treatment and have already gone home after birth will most often be admitted to the hospital for monitoring.

Outlook (Prognosis)

Many babies with bacterial infections will recover completely and have no other problems. However, neonatal sepsis is a leading cause of infant death. The more quickly an infant gets treatment, the better the outcome.

Possible Complications

Complications may include:

• Disability
• Death

When to Contact a Medical Professional

Seek medical help right away for an infant that shows symptoms of neonatal sepsis.

Prevention

Pregnant women may need preventive antibiotics if they have:

• Chorioamnionitis
• Group B strep colonization
• Given birth in the past to a baby with sepsis caused by bacteria

Other things that can help prevent sepsis include:

• Preventing and treating infections in mothers, including HSV
• Providing a clean place for birth
• Delivering the baby within 12 to 24 hours of when the membranes break (Cesarean delivery should be done in women within 4 to 6 hours or sooner of membranes breaking.)

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