Neonatal Sepsis

Neonatal sepsis is one of the common diseases in child and newborn. If your newborn has neonatal sepsis, here is all you need to know about it.

Causes

Neonatal sepsis may be caused by bacteria like Listeria, Escherichia coli (E. coli), and certain strains of streptococcus. A major cause is Group B streptococcus (GBS). But, this problem has lowered as women are monitored during pregnancy.

A neonate may get a severe infection from the herpes simplex virus (HSV) also. It commonly happens when the mother is newly infected.

Risk factors

Early-onset neonatal sepsis

It usually appears within 24-48 hours of birth. The infection is acquired from the mother pre or during delivery. The risk factors are:

  • Preterm delivery
  • GBS colonization while pregnant
  • Rupture of membranes (water breaking) more than 18 hours pre-birth
  • Infection of the amniotic fluid (chorioamnionitis) and placental tissues

Late-onset neonatal sepsis

It infects babies after delivery. The risk factors include:

  • Staying in the hospital for an extended time period
  • Presence of a catheter in a blood vessel for a long time

Symptoms

Newborns with neonatal sepsis may develop the following symptoms:

  • Temperature instability (hyperthermia or hypothermia)
  • Breathing problems
  • Diarrhoea or reduced bowel movements
  • Vomiting
  • Low blood sugar
  • Decreased sucking
  • Reduced movements
  • Seizures
  • Swollen belly area
  • Fast or slow heart rate
  • Jaundice (yellow skin and the whites of the eyes) 

Treatment

Common Treatments

General treatment of neonatal sepsis includes:

  • Antibiotic therapy
  • Supportive therapy

Babies below 4 weeks of age who get a fever or show other symptoms of infection are started on intravenous (IV) antibiotics immediately. The lab results may be received within 24-72 hours. Neonates whose mothers had chorioamnionitis or who are at high risk for other factors also receive IV antibiotics initially, even if they show no symptoms.

If bacteria are found in the spinal fluid or blood, antibiotics will be given to the baby for up to 3 weeks. If no bacteria are spotted, treatment will take less time.

In case of infections caused by HSV, an antiviral medicine called acyclovir is given. Antibiotics may not be given to older babies with only a fever and normal lab results. Instead, the child can probably leave the hospital and return for checkups.

General supportive measures that are combined with antibiotic treatments include respiratory and hemodynamic management.

Babies who have already gone home after birth and require treatment will be mostly monitored after being admitted to the hospital.

Other Treatments

  • Exchange transfusions may be used for critically ill (specifically metabolically acidic and hypotensive) neonates. These are administered to raise the levels of circulating immunoglobulins and Hb levels, reduce circulating endotoxin and promote perfusion. But, they have no controlled prospective studies.
  • Fresh frozen plasma may help reverse the heat-labile and heat-stable opsonin deficiencies in LBW neonates. But, transfusion-associated risks are there.
  • Granulocyte transfusions may be used in granulocytopenic and septic neonates but do not convincingly improve the results.
  • Recombinant colony-stimulating factors (granulocyte-macrophage-colony-stimulating factor [GM-CSF] and granulocyte colony-stimulating factor [G-CSF]) have improved neutrophil count and function in newborns with presumed sepsis. They aren’t of routine benefit for severe neutropenia. 

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