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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. Occurs after 1 week and before 3 months of age.

Alternative Names

Sepsis neonatorum; Neonatal septicemia; Sepsis - infant

Causes

Neonatal sepsis can be caused by bacteria such as Escherichia coli (E.coli), Listeria, and some strains of streptococcus. The herpes virus can also cause a severe infection in a newborn baby.

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

  • Group B streptococcus infection during pregnancy
  • Preterm delivery
  • Water breaking (rupture of membranes) longer than 24 hours before birth
  • Infection of the placenta tissues and amniotic fluid (chorioamnionitis)

Babies with late-onset neonatal sepsis get infected after delivery. The following increase an infant's risk of 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
  • Low blood sugar
  • Reduced movements
  • Reduced sucking
  • Seizures
  • Slow or fast heart rate
  • Swollen belly area
  • Vomiting
  • Yellow skin and whites of the eyes (jaundice)

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
  • Complete blood count (CBC)

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 herpes virus if the mother has a history of 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 infection are started on intravenous (IV) antibiotics right away. (It may take 24 to 72 hours to get lab results.)

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 medication called acyclovir will be used for infections that may be caused by the herpes virus. 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 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

  • 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:

  • Infection in the placenta
  • Group B strep infection
  • 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 herpes infection
  • Providing a clean place for birth
  • Delivering the baby within 24 hours of when the membranes break

References

American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newborn. Policy Statement: Recommendations for the Prevention of Perinatal Group B Streptococcal (GBS) Disease. Pediatrics. 2011: 128(3):611-616.

Verani JR, McGee L, Schrag S. Prevention of Perinatal Group B Streptococcal Disease, Revised Guidelines from CDC, 2010. Morbidity and Mortality Weekly Report. 59(RR-10): 1-36, 2010.

Stoll et al. Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues. Pediatrics. 2011: 127:817-826.

Updated: 4/26/2013

Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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