Definition

Neonatal sepsis is a serious medical condition that occurs when newborns, also known as neonates (aged less than 28 days), develop a severe infection. Sepsis arises when the body overreacts to an infection, leading to widespread inflammation. In newborns with infection and sepsis, this inflammation can affect the entire body, causing reduced blood flow to the baby's limbs and vital organs due to inflammation and blood clotting. This can potentially result in organ failure and death.

Doctors categorize neonatal sepsis into two main types based on the timing of onset:

• Early-onset neonatal sepsis occurs within the first 72 hours of life.
• Late-onset neonatal sepsis occurs after the first three days of life.

Neonatal sepsis can indeed be treated, and many newborns recover completely without any lasting issues. However, it remains one of the leading causes of death among newborns. Timely treatment is crucial for improving outcomes. The risk of death due to sepsis increases by about 7.6% for every hour that passes without appropriate therapy.

Causes

Bacterial infections, including pathogens like E. coli, Listeria, and Group B Streptococcus (GBS), are the primary culprits behind neonatal sepsis. However, viruses, fungi, and parasites can also trigger this condition. For instance, the herpes simplex virus (HSV) is known to cause severe infections in newborns, contributing to cases of neonatal sepsis.

Newborns can develop sepsis through different pathways depending on the timing of onset:

• Early-onset neonatal sepsis: This occurs when newborns acquire the infection from their mother before or during delivery. Factors that increase the risk of early-onset neonatal sepsis include:
• Maternal colonization with bacteria such as Group B Streptococcus (GBS) in the vagina during pregnancy.
• Premature birth.
• Prolonged rupture of membranes (more than 18 hours before delivery).
• Infection in the placenta and amniotic fluid known as chorioamnionitis.
• Late-onset neonatal sepsis: In this scenario, newborns develop the infection after birth, typically from bacteria in their environment. Risk factors for late-onset neonatal sepsis include:
• Low birth weight.
• Need for respiratory support.
• Requirement for antibiotics.
• Placement of catheters, such as IV lines or urinary catheters, for an extended period.
• Treatment for other conditions necessitating a prolonged hospital stay.

Risk factor

Neonatal sepsis can affect all newborns, but premature newborns are more susceptible compared to full-term newborns due to their underdeveloped immune systems. Premature newborns may lack antibodies to protect themselves from specific bacteria because they have not yet received sufficient antibodies from their mothers. 

Additionally, neonatal sepsis often occurs in newborns who:

• Have low birth weight.
• Exhibit a low Apgar score at birth, indicating potential health challenges.
• Are born to mothers with specific risk factors, such as infections during pregnancy.

Symptoms

The symptoms of neonatal sepsis can sometimes mimic those of other common illnesses in newborns. However, if your newborn displays more than one of the following symptoms or appears unusually unwell, it's essential to seek immediate medical attention.

Symptoms of neonatal sepsis include:

• Fever or abnormally low body temperature
• Rapid or slow heart rate
• Rapid or labored breathing
• Vomiting
• Diarrhea
• Decreased appetite or difficulty feeding
• Swollen abdomen
• Cold extremities (hands and feet)
• Damp and pale skin
• Jaundice (yellowing of the skin and whites of the eyes)
• Reduced activity level
• Seizures

Diagnosis

The doctor will evaluate your baby's symptoms and discuss your health history.

The doctor will recommend tests to diagnose the cause of your baby's infection. These tests may include:

• Blood tests: complete blood count, blood culture, and C-reactive protein
• Urinalysis and urine culture
• Lumbar puncture: the doctor inserts a very small needle into the space between your baby's spinal bones to collect spinal fluid to check for infection
• Imaging examination: chest X-ray or ultrasound

Management

The management of neonatal sepsis should commence promptly. Doctors may admit your baby to the intensive care unit (ICU). Therapy for neonatal sepsis may include:

• Fluid infusion
• Antibiotic infusion to combat bacterial infection
• Antiviral medication to combat viral infection
• Medication for the heart and/or blood pressure
• Provision of oxygen support or other respiratory assistance, if necessary

Complications

Most newborns who recover from sepsis do not experience any complications. However, many surviving babies face long-term health problems. More than a third of babies who survive sepsis will experience cognitive delays.

Some babies develop an infection in the membranes surrounding the brain called meningitis. Newborns with this condition may experience serious symptoms and side effects, such as:

• Extreme lethargy
• Bulging fontanelle
• Hearing impairment
• Developmental delays
• Cerebral palsy
• Seizures
• Coma

Prevention

Your obstetrician may recommend taking preventive antibiotics to prevent transmitting infection to your baby. Your doctor will administer antibiotic infusions for several hours before delivery if:

• You have an infection such as chorioamnionitis
• You have group B strep colonization in the vagina
• You have previously given birth to a baby with sepsis

Additionally, there are several steps you can take to prevent sepsis, such as:

• Practicing good hygiene
• Regular check-ups with your doctor
• Getting recommended vaccines
• Recognizing signs of sepsis
• Seeking immediate medical help if you suspect yourself or your baby is experiencing sepsis

When to see a doctor?

If you're at home and your newborn baby shows any of the following symptoms of sepsis, immediately call emergency services or go to the nearest emergency department. You can also monitor the following symptoms:

• Your baby is more irritable or drowsy than usual
• Your baby's skin feels cold, appears pale, or changes color
• Your baby hasn't urinated for more than 12 hours
• Your baby is unresponsive or experiencing difficulty breathing

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