Neonatal sepsis is a blood infection in an infant under 28 days old. It occurs when the body has an extreme response to an infection, causing widespread inflammation that can interfere with blood flow to vital organs. This condition is a medical emergency that requires immediate intervention to prevent organ failure and other severe health complications.
Causes and Risk Factors
Neonatal sepsis is categorized into two types based on when the infection begins. Early-onset sepsis develops within the first 72 hours of life and is acquired from the mother before or during delivery. The most frequent bacteria are Group B Streptococcus (GBS) and Escherichia coli (E. coli). Risk factors include the mother testing positive for GBS, preterm delivery, a prolonged period between the water breaking and birth, or an infection of the placental tissues (chorioamnionitis).
Late-onset sepsis occurs after the first week of life and is acquired from the infant’s environment. Newborns requiring extended hospital stays, particularly in a neonatal intensive care unit (NICU), are more susceptible. Long-term medical devices, like catheters, can introduce bacteria. Common infectious agents include Staphylococcus aureus and certain species of Klebsiella and Pseudomonas. Premature infants with underdeveloped immune systems are particularly vulnerable.
Recognizing the Symptoms
The signs of neonatal sepsis can be subtle and easily mistaken for other newborn issues. Common symptoms include:
- An unstable body temperature, which may be a fever or a low body temperature (hypothermia)
- Changes in breathing patterns, such as breathing very fast, making grunting sounds, or brief pauses in breathing (apnea)
- Difficulties with feeding, including a reduced interest in sucking, feeding poorly, or a swollen abdomen
- Changes in behavior, such as unusual sleepiness, limpness, or persistent irritability
- Pale or blotchy skin
- Yellowing of the skin and eyes (jaundice)
Diagnosis and Treatment
The primary method for confirming a blood infection is a blood culture, which tests a small sample of the baby’s blood for bacteria. While waiting for culture results, which can take 24 to 72 hours, other lab tests are performed. These include a complete blood count (CBC) to check for signs of infection and a C-reactive protein (CRP) test to detect inflammation.
If the infection is suspected to have spread to the central nervous system, a lumbar puncture (spinal tap) analyzes cerebrospinal fluid for bacteria and meningitis. Depending on the symptoms, a chest x-ray may check for breathing problems or a urine culture for a urinary tract infection.
Treatment with intravenous (IV) antibiotics begins immediately, even before a definitive diagnosis is made. The specific antibiotic may be adjusted once the blood culture identifies the bacteria causing the sepsis. Infants often require supportive care in a NICU, which can include breathing assistance from a ventilator, IV fluids for hydration, and continuous monitoring of vital signs.
Prognosis and Recovery
With prompt diagnosis and treatment, the majority of newborns with neonatal sepsis recover completely. The speed of treatment is directly linked to the outcome, as delays increase the risk of severe complications or death. While survival rates are high with timely care, the condition remains a leading cause of infant mortality globally.
In some cases, particularly if sepsis was severe or led to complications like meningitis, long-term effects like developmental delays or hearing loss can occur. Follow-up appointments with a pediatrician after discharge are important to monitor the infant’s growth and development, allowing any potential issues to be addressed early.