Neonatal Sepsis

(Sepsis, Neonatal)
by Julie Rackliffe Lucey, MS En Espaol (Spanish Version)

Definition
Neonatal sepsis is a bacterial infection in the blood. It is found in infants during the first month of life. This may become a serious condition. If you suspect your baby has this condition, contact your doctor right away. Spread of Infection

2011 Nucleus Medical Media, Inc.

Causes
The cause relates to the baby being exposed to bacteria. Early onset sepsis that develops within the first week is from the mother (via the placenta or from passing through the birth canal). Late onset sepsis that develops after one week is from the caregiving environment. Intrapartum antibiotics have been successful in preventing early onset bacterial sepsis. Some factors related to your pregnancy or health also add to the chance that your baby can get this condition: Labor complications resulting in traumatic or premature delivery Water has broken more than 18 hours prior to giving birth Fever or other infection while you are in labor
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Need for a catheter for a long time while you are pregnant

Risk Factors
The following factors increase your childs chance of developing neonatal sepsis: Baby is born more than three weeks before your due date (premature) Going into labor more than three weeks before your due date Baby is in distress before being born Baby has a very low birth weight Baby has a bowel movement before being born, and fetal stool is in the uterus Amniotic fluid surrounding the baby has a bad smell or the baby has a bad smell right after being born Male babies are at greater risk for neonatal sepsis than female babies.

Symptoms
In most cases, symptoms are present within 24 hours of birth. In almost all cases, they will be present within 48 hours of birth. If your baby has any of these symptoms do not assume it is due to neonatal sepsis. These symptoms may be caused by other, less serious health conditions. However, if your baby does have any one of them, see your doctor. Fever or frequent changes in temperature Poor feeding from breast or bottle Decreased or absent urination Bloated abdomen Vomiting yellowish material Diarrhea Extreme redness around the belly button Skin rashes Unexplained high or low blood sugar Difficulty waking the baby or unusual sleepiness Jaundiced or overly pale skin Abnormally slow or fast heartbeat Breathing rapidly, difficulty breathing, or periods of no breathing (apnea) Bruising or bleeding Seizures Cool, clammy skin

Diagnosis
Your doctor will ask about your babys symptoms and medical history, and perform a physical exam. Tests may include the following: Complete blood count Cultures of: Blood Urine Cerebrospinal fluid
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Skin lesions X-rays of the chest

or abdomen

Treatment
Talk with the doctor about the best treatment plan for your baby. Treatment depends on how severe the condition is. Treatment may last 2-21 days. In general, babies suspected of sepsis are hospitalized for at least two days to wait for culture results. A well-appearing infant may be monitored without antibiotics. The infant is sent home when cultures are negative. Culture-proven sepsis is treated for 7-21 days, depending on the location of the infection. Treatment options include:

Antibiotics
Antibiotic medicine may have to be given intravenously (IV).

Intravenous Fluids
The baby may need to receive fluids, glucose, and electrolytes through an IV.

Oxygen
The baby may need to be given oxygen or have help with his ventilation (breathing).

Prevention
To reduce your babys chance of getting neonatal sepsis, your doctor may take the following steps: If you have given birth to a baby with neonatal sepsis before, your doctor may give you antibiotics close to your due date. This can kill dangerous bacteria in the birth canal before the baby is exposed to it. The doctor can test you for the bacteria before your due date and give you antibiotics to get rid of it if needed. Breastfeeding may also help prevent sepsis in some infants.
RESOURCES:

Auckland (New Zealand) District Health Board http://www.adhb.govt.nz/newborn/Default.htm/ Minnesota Department of Health http://www.health.state.mn.us/
CANADIAN RESOURCES:

Health Canada http://www.hc-sc.gc.ca/index-eng.php Sick Kids http://www.sickkids.ca/

REFERENCES:
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Behrman RE, Kliegman RM, and Jenson HB. Nelson Textbook of Pediatrics . 18th ed. Philadelphia, PA: Saunders; 2007. Herbst A, Klln K. Time between membrane rupture and delivery and septicemia in term neonates. Obstet Gynecol . 2007 Sep;110(3):612-8. Neonatal sepsis. EBSCO DynaMed website. Available at: http://dynaweb.ebscohost.com . Accessed June 8, 2008 Kleigman RM, Behrman RE, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics . 18th ed. Philadelphia, PA: Saunders; 2004. Neonatal infections. The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.c... . Accessed September 18, 2005. Neonatal sepsis. Parental Advisory Council: Leadership, Advocacy, and Consultation website. Available at: http://www.paclac.org/Manuals_Guidelines/manuals_guidelines.htm . Accessed September 18, 2005.

Last reviewed September 2011 by J. Thomas Megerian, MD, PhD, FAAP Last Updated: 9/30/2011

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