Neonatal sepsis


Neonatal sepsis

Description, Causes and Risk Factors:

ICD-10: P36.9

Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. It encompasses various systemic infections of the newborn such as septicemia, meningitis, pneumonia, arthritis, osteomyelitis, and urinary tract infections (UTIs). Superficial infections like conjunctivitis and oral thrush are not usually included under neonatal sepsis.

Neonatal sepsis can be classified into two major categories depending up on the onset of symptoms.

Early onset sepsis (EOS): It presents within the first 72 hours of life. In severe cases, the neonate may be symptomatic at birth. Infants with EOS usually present with respiratory distress and pneumonia. The source of infection is generally the maternal genital tract. Some maternal/perinatal conditions have been associated with an increased risk of EOS. Knowledge about these potential risk factors would help in early diagnosis of sepsis. Based on the studies from India, the following risk factors seem to be associated with an increased risk of early onset sepsis:

    Low birth weight (<2500 grams) or prematurity.

  • Febrile illness in the mother with evidence of bacterial infection within 2 weeks prior to delivery.

  • Foul smelling and/or meconium stained liquor.

  • Rupture of membranes >24 hours.

  • Single unclean or > 3 sterile vaginal examinations during labor.

  • Prolonged labor (sum of 1st and 2nd stage of labor > 24 hrs).

  • Perinatal asphyxia (Apgar score <4 at 1 minute).

Late onset sepsis (LOS): It usually presents after 72 hours of age. The source of infection in LOS is either nosocomial (hospital-acquired) or community-acquired and neonates usually present with septicemia, pneumonia or meningitis. Various factors that predispose to an increased risk of nosocomial sepsis include low birth weight, prematurity, admission in intensive care unit, mechanical ventilation, invasive procedures, administration of parenteral fluids, and use of stock solutions. Factors that might increase the risk of community-acquired LOS include poor hygiene, poor cord care, bottle-feeding, and prelacteal feeds. In contrast, breastfeeding helps in prevention of infections.

The microbial etiology of neonatal sepsis varies in different parts of the world and often changes over the years. In Indian studies, Gram-negative organisms have been more frequently responsible for sepsis (65-85%) as compared to Gram-positive organisms. NNPD data show that Gram-negative organisms account for nearly 56% of sepsis among intramural neonates and 63% of sepsis among extramural neonates.

    Common organisms: Klebsiella, Escherichia coli (E. coli), Pseudomonas and Staphylococcus aureus (S. aureus).

  • Less common organisms: Enterobacter, Citrobacter, Salmonella and Streptococcus groups B and D.

  • Uncommon organisms: Group B streptococcus (common cause of neonatal sepsis in the West, but infrequent in India).

  • Organisms in EOS: Streptococcus agalactiae, E. coli, Haemophilus influenza and Listeria monocytogenes.

  • Organisms in LOS: Coagulase-negative Staphylococcus (CONS), S. aureus, E. coli, Klebsiella species, Pseudomonas aeruginosa, Enterobacter species, Candida species, Streptococcus agalactiae, Serratia species, Acinetobacter species and anaerobes.

  • Organisms in LBW neonates with sepsis: Coagulase-negative Staphylococcus (CONS) and Acinetobacter.

Symptoms:

Neonates with sepsis may present with oneor more of the following symptoms andsigns:

    Hypothermia or fever (the former is morecommon in preterm LBW infants).

  • Lethargy, poor cry, refusal to suck.

  • Poor perfusion, prolonged capillary refilltime.

  • Hypotonia, absent neonatal reflexes.

  • Brady/tachycardia.

  • Respiratory distress, apnea and gaspingrespiration.

  • Hypo/hyperglycemia.

  • Metabolic acidosis.

Diagnosis:

There is no definite marker in neonatal sepsis, but there aredeterminants of infection.When a neonate presents with sepsis symptoms a septic work-upis completed. The things included in septic work up may include:

    Complete Blood Count (CBC).

  • Blood & Urine cultures.

  • Lumbar Puncture (LP).

  • Chest X-Ray.

  • Line cultures.

Treatment:

It is of vital importance that treatment is initiated as soon as sepsis is suspected, especially for those infants at risk. Broad spectrum antibiotics are the first line of defense against neonatal sepsis. Antibiotics should be initiated after all cultures and lab work is completed to ensure proper diagnosis. All neonates will remain on IV antibiotics until blood/urine culture results come back in approximately 2-3 days. Further therapy will depend on lab work results and the neonate's response to treatment. Although antibiotic therapy is vital, it is just as important to continue the overall support of the neonate (i.e. respiratory & cardiac).

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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