What is neonatal sepsis?

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 are 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; they may be
caused by other, less serious health conditions. However, one should consult a
doctor if the baby displays any of the following: a fever or frequent changes in
temperature; 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 will
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

One should 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 to receive antibiotic medication, fluids, glucose, and electrolytes intravenously,or to receive oxygen to help with ventilation (breathing).

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 also may test the woman for the bacteria before the due date and prescribe antibiotics, and he or she may recommend breast-feeding, which can help prevent sepsis in some infants.

Bibliography

Behrman, Richard E., Robert M. Kliegman, and Hal B. Jenson, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders/Elsevier, 2007.

EBSCO Publishing. DynaMed: Neonatal Sepsis. Availablethrough http://www.ebscohost.com/dynamed.

Herbst, A., and K. Källén. “Time Between Membrane Rupture and Delivery and Septicemia in Term Neonates.” Obstetrics and Gynecology 110, no. 3 (September, 2007): 612-618.

Martin, Richard J., Avroy A. Fanaroff, and Michele C. Walsh, eds. 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, eds. Merenstein and Gardner’s Handbook of Neonatal Intensive Care. 7th ed. Maryland Heights, Mo.: Mosby/Elsevier, 2011.