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What is sepsis?
Sepsis is a term for severe infection that is present in the blood and spreads throughout the body. In newborns, it is also called sepsis neonatorum or neonatal septicemia.
What causes sepsis?
Sepsis can develop following infection by microorganisms including bacteria, viruses, fungi, and parasites. Infection in babies can be contracted during pregnancy, from the mother's genital tract during labor and delivery, or after birth from contact with others. Sepsis in a newborn is more likely to develop when the mother has had pregnancy complications that increase the likelihood of infection. Such complications may include the following:
premature rupture of the membranes (amniotic sac), or membrane rupture for an extended length of time bleeding problems a difficult delivery infection in the uterus or placental tissues fever in the mother
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Babies can also develop sepsis by contracting infections after birth from infected persons or objects. Babies in the newborn intensive care unit (NICU) are at increased risk for acquiring nosocomial (hospital-acquired) infections. Many babies in the NICU are premature or have low birthweight which makes them more susceptible to infection and more likely to need invasive treatments and procedures. Microorganisms that normally live on the skin may cause infection if they enter the body through catheters and other tubes inserted into the baby's body.
What microorganisms cause severe infections and sepsis in babies?
Prenatal rubella (German measles) During Delivery After Birth Group B streptococcus (GBS) respiratory syncytial virus (RSV)
Candida Haemophilus influenzae type b (Hib) enterovirus
varicella-zoster virus herpes simplex (chickenpox virus) virus Listeria monocytogenes .
Why is sepsis a concern?
Sepsis can be life threatening for newborns, especially if the baby has a weakened immune system because of prematurity or another illness. When a baby's immature immune system cannot fight the microorganism, the infection can quickly spread and overtake the body, causing serious illnesses such as meningitis or pneumonia.
What are the symptoms of sepsis?
Sepsis in newborns is not always easy to identify since newborn babies often do not show symptoms of infections in the same way older babies and children may show symptoms. The following are some of the symptoms of infection in newborn babies. However, each baby may experience symptoms differently depending upon the type of organism causing the infection and the severity and location of the infection. Symptoms of infection may include the following:
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apnea (stopping breathing) or difficulty breathing bradycardia (decreased heart rate) decreased temperature or temperature instability weak suck jaundice (yellow coloring of the skin and eyes)
How is sepsis diagnosed?
A sepsis workup may be needed to help identify the location of the infection and type of microorganism causing the infection. A sepsis workup may include the following procedures:
blood tests lumbar puncture (Also called spinal tap.) - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord.
blood cultures urine culture (sometimes by suprapubic tap, insertion of a needle through the lower abdomen into the bladder) culture of fluids from inside tubes and catheters that are inserted in the baby x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Procedures may also be performed to determine which antibiotics or medications are most effective for treating the specific microorganism.
Treatment of sepsis:
Specific treatment for sepsis will be determined by your baby's physician based on:
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your baby's age, overall health, and medical history extent of the disease your baby's tolerance for specific medications, procedures, or therapies expectations for the course of the disease your opinion or preference
Early diagnosis and treatment of the infection are important in helping prevent sepsis from overwhelming a baby's body. However, cultures of blood and body fluids may take several days for the organism to grow and be identified. Because of this, babies who are at increased risk for sepsis, such as premature or low birthweight babies, may have preventive antibiotic treatment started as soon as cultures are taken. Most medications are given intravenously (IV). Sepsis can be life threatening as the infection can affect several body systems at the same time. This can make providing treatment more difficult. Babies with sepsis will require care in the newborn intensive care unit (NICU), and may need antibiotics, other medications, and specialized treatment (such as a mechanical breathing machine). The healthcare team will be working to provide the best care to treat the infection and care for your baby. Click here to view the Online Resources page of this Web Site.
2. Sepsis Neonatorum
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Definition Symptoms Diagnosis Prognosis and Treatment
Sepsis in a newborn (sepsis neonatorum) is an infection that spreads throughout the baby’s body. Sepsis occurs in less than 1 percent of newborns (1 out of every 100), but accounts for up to 30 percent of deaths in the first few weeks of life. Infection is 5-10 times more common in premature newborns and in babies weighing less than 5½ pounds than in normal-weight, full-term newborns. Complications experienced during birth, such as premature or prolonged rupture of the membranes or infection in the mother, put the newborn at increased risk of infection. Symptoms The onset of what is called early-onset neonatal sepsis is within six hours of birth in over half the cases and within 72 hours in the great majority of cases. Sepsis that begins four or more days after birth is called late-onest sepsis, and is probably an infection acquired in the hospital nursery (a nosocomial infection). In both types of neonatal sepsis, the infection may be only in the bloodstream, or may spread to the lungs (pneumonia), brain (meningitis), bone (osteomyelitis), joints, or other organs in the body. Typical symptoms of a newborn with sepsis include:
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listlessness (a very sleepy baby) feeding problems a high OR low temperature
Other symptoms include:
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difficulty breathing, rapid breathing, or apnea (when the baby stops breathing) seizures excessive jitteriness repeated vomiting or diarrhea a swollen abdomen
Diagnosis The organism that is causing the infection may be identified by taking cultures of the blood as well as from other sites of the body. Urine samples are often cultured for bacteria to look for an infection in the urinary tract. Because only small samples of blood and other body fluids are taken, sometimes no organism is found. However, the infant may still be treated if other laboratory studies or the infant’s clinical appearance strongly suggest an infection. Other laboratory studies that doctors use to detect an infection include the following:
White Blood Cell Count and Differential: When an infant is fighting an infection, their white blood cell count may either go up, as the infant’s body produces more infection-fighting cells, or it might also go down if the infant has used up all of their white blood cells fighting the infection and can no longer keep up with their production of white cells. Another change that is seen when an infant is fighting an infection is an increase in the percentage of immature white cells. This is due to the increased production rate of white blood cells, such that more immature white blood cells are being released into the blood stream. This higher percentage of immature white cells is sometimes referred to as a “leftshift,” and is one of the things that can tell the doctors that the infant has an infection. C-Reactive Protein (CRP): This is a laboratory test that measures a protein that is a non-specific marker for inflammation and therefore infection. If the infant has two normal CRP levels measured 24 hours apart, then there is a 99% chance that the infant does not have an infection. Therefore, this test is most useful in ruling out an infection. Lumbar Puncture: If the doctor suspects meningitis, which is more common if something has grown in the baby’s blood culture, a spinal tap, or lumbar puncture will be performed. Lumbar punctures allow the doctor to obtain a small amount of cerebrospinal fluid (CSF), which is the protective fluid that surrounds the brain and the spinal cord. The CSF can then be cultured to determine if the bacteria has spread to the nervous system. The doctor, nurse practitioner, or physician’s assistant will very carefully insert a special spinal needle between two vertebrae, or backbones, in the baby’s back at a level below where the actual spinal cord ends, so there is no danger that the needle will come into contact with the baby’s spinal cord. After a very small amount of fluid is removed, the needle is taken out, and a band-aid placed on the baby’s back.
The spinal needle is inserted (left) below where the spinal cord ends (right.) Prognosis and Treatment Sepsis in a newborn is treated with antibiotics given intravenously. Antibiotics are often started even before laboratory and culture results are available. The doctor may then switch to a different antibiotic that is more specific to the baby’s infection once the results of laboratory tests are back. The length of antibiotic treatment varies depending on the infant’s clinical status, laboratory test results, and kind of infection. If blood cultures and other laboratory tests are all negative, antibiotics may be stopped after 48 hours of treatment. If the infant’s cultures are positive, or if the laboratory tests and clinical status are suggestive of infection, the infant will be treated with antibiotics, usually anywhere from 7-14 days. When appropriately treated with antibiotics and cared for in the intensive care unit, the great majority of newborns with sepsis live without any long-term problems.
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