Summary about Disease
Neonatal sepsis is a bloodstream infection that occurs in an infant younger than 90 days old. It is a serious condition because the infection can spread rapidly and be life-threatening. Neonatal sepsis is broadly categorized as early-onset sepsis (EOS), occurring within the first 7 days of life, or late-onset sepsis (LOS), occurring after 7 days of life.
Symptoms
Symptoms can be subtle and non-specific, making diagnosis challenging. Common signs include:
Fever (though some infants may have low body temperature or temperature instability)
Lethargy (appearing unusually sleepy or inactive)
Poor feeding or difficulty feeding
Irritability
Breathing problems (rapid breathing, grunting, or apnea - pauses in breathing)
Rapid heart rate
Low blood pressure
Jaundice (yellowing of the skin and eyes)
Seizures
Swollen abdomen
Vomiting or diarrhea
Skin rashes or lesions
Causes
Early-onset sepsis (EOS): Usually caused by bacteria acquired from the mother during birth, often from the vaginal or gastrointestinal tract. Common culprits include Group B Streptococcus (GBS), Escherichia coli (E. coli), and Listeria monocytogenes.
Late-onset sepsis (LOS): Can be caused by bacteria or fungi acquired from the environment after birth, such as in the hospital setting (e.g., contaminated equipment, healthcare workers' hands), or from the community. Common pathogens include Staphylococcus aureus, coagulase-negative staphylococci, E. coli, Klebsiella, Pseudomonas, and Candida species. Risk factors include prematurity, low birth weight, prolonged hospital stay, central venous catheters, and mechanical ventilation.
Medicine Used
Antibiotics: Broad-spectrum antibiotics are started immediately after sepsis is suspected, even before cultures are back, to cover a wide range of potential bacteria. Common initial choices include ampicillin and gentamicin, or ampicillin and cefotaxime. Once the specific bacteria is identified from blood cultures, antibiotics are tailored to target the specific organism.
Antifungals: If fungal infection is suspected, antifungal medications like amphotericin B or fluconazole may be used.
Supportive Care: Other medications might include vasopressors to maintain blood pressure, inotropes to improve heart function, and medications to control seizures.
Is Communicable
Neonatal sepsis itself isn't directly communicable from infant to infant like a viral infection (e.g., a cold). However, the bacteria or *fungi* causing the sepsis can be transmitted. For early onset sepsis, transmission is from mother to baby. For late onset sepsis, the pathogens can be transmitted from healthcare workers, contaminated equipment, or the environment. Strict hygiene practices are essential to prevent the spread of these organisms.
Precautions
Maternal screening: Screening pregnant women for Group B Streptococcus (GBS) and treating with antibiotics during labor if positive.
Hand hygiene: Strict handwashing protocols for all healthcare workers, family members, and visitors.
Aseptic technique: Using sterile techniques when inserting catheters, IV lines, and other invasive devices.
Environmental hygiene: Cleaning and disinfecting surfaces and equipment regularly.
Breastfeeding: Encouraging breastfeeding, as breast milk provides antibodies and immune factors.
Limiting visitors: Reducing the number of visitors to the neonatal intensive care unit (NICU).
Early recognition: Promptly identifying and treating suspected infections.
How long does an outbreak last?
Outbreaks of late-onset sepsis in NICUs can vary in duration. They can last from a few weeks to several months, depending on the source of the infection, the effectiveness of infection control measures, and the number of infants affected. Control measures are implemented immediately and continuously monitored until the outbreak is declared over, with no new cases for a defined period (e.g., 2-4 weeks).
How is it diagnosed?
Blood culture: The gold standard for diagnosis. A blood sample is taken and sent to the lab to see if bacteria or fungi grow.
Complete blood count (CBC): Can show elevated white blood cell count, low platelet count, or other abnormalities.
C-reactive protein (CRP): An inflammatory marker that may be elevated.
Procalcitonin (PCT): Another inflammatory marker that can be elevated in sepsis.
Cerebrospinal fluid (CSF) analysis: If meningitis (infection of the brain and spinal cord) is suspected, a lumbar puncture (spinal tap) may be performed to analyze the CSF.
Urine culture: To rule out urinary tract infection.
Chest X-ray: If pneumonia is suspected.
Clinical Assessment: Combining the above tests with observations of the infant's symptoms and risk factors.
Timeline of Symptoms
The timeline of symptoms can vary.
Early-onset sepsis (EOS): Symptoms typically appear within the first 24-48 hours of life, but can occur up to 7 days.
Late-onset sepsis (LOS): Symptoms appear after 7 days of age, and there is no specific timeline, but it depends on the bacterial load, immune system of the baby and other health factors of the baby.
Important Considerations
Prematurity: Premature infants are at higher risk for sepsis due to their immature immune systems.
Rapid progression: Sepsis can progress very quickly in newborns, so prompt diagnosis and treatment are crucial.
Long-term complications: Even with treatment, sepsis can lead to long-term complications such as developmental delays, hearing loss, and cerebral palsy.
Mortality: Neonatal sepsis remains a significant cause of infant mortality.
Empiric therapy: Due to the rapid progression of the disease, empiric antibiotic therapy (starting treatment before the causative organism is identified) is essential.
Consultation: A neonatologist or pediatric infectious disease specialist should be involved in the management of neonatal sepsis.