What is Neonatal Sepsis?
Neonatal Sepsis refers to an infection of the newborn, specifically bacterial blood stream infections (BSI). Some of the systematic infections commonly seen in Neonatal Sepsis or Sepsis in Infants are meningitis, septicemia, pneumonia, arthritis, pyelonephritis, osteomyelitis, and gastroenteritis. All of these conditions have one symptom in common and that is fever in the newborn baby. Neonatal Sepsis or Sepsis in Infants is also known by the name of sepsis neonatorum. Hemodynamic compromise caused due to Neonatal Sepsis or Sepsis in Infants is difficult to measure and taken care of as symptoms usually do not emerge until it is too late and death of the infant becomes imminent.
What are the Classifications of Neonatal Sepsis?
Sepsis in Infants or Neonatal Sepsis has two subtypes which are the early onset sepsis and late-onset sepsis. In early onset sepsis, the condition is detected as early as 72 hours of the baby being born or within a week of the birth of the baby. In Late Onset Sepsis, the condition is detected much later but within 90 days of life of the infant.
How Common is Neonatal Sepsis?
Sepsis in Infants or Neonatal Sepsis is one of the major cause of neonatal deaths in developing countries in hospitals. Sepsis in infants is the one and only vital cause behind neonatal deaths in hospital as well as communities in developing countries. In the United States it is one of the leading causes of neonatal deaths in hospital affecting on an average 30,000 babies born annually in the country.
What are the Causes of Neonatal Sepsis?
Neonatal Sepsis or Sepsis in Infants is basically caused by a bacterial infection. There are many types of bacteria which may cause Neonatal Sepsis or Sepsis in Infants like Listeria monocytogenes, Escherichia coli, Group B Streptococcus, Streptococcus pneumoniae, Neisseria meningitides, Salmonella, Haemophilus influenzae type B. Herpes Simplex Virus is yet another cause for Neonatal Sepsis or Sepsis in Infants. A child may get this condition from the mother who may have been exposed to this virus as a result of unprotected sex or having sex with multiple partners.
Early-onset Neonatal Sepsis or Sepsis in Infants is inherited from the mother meaning that the offending bacteria or virus was present in the mother and had been passed to the baby causing this condition. The bacteria may be present in the birth canal and the baby may get it at the time of birth while passing through the birth canal.
Some of the bacteria which tend to cause early onset Neonatal Sepsis or Sepsis in Infants are Escherichia coli, Group B Streptococcus, Haemophilus influenzae, Coagulase-negative Staphylococcus and Listeria monocytogenes. Some of the factors which increase the risk of a baby being born with Neonatal Sepsis or Sepsis in Infants are preterm delivery, infection of the placental tissues and amniotic fluid, and rupture of membranes about 18 hours before birth.
Coming to late onset Neonatal Sepsis or Sepsis in Infants, some of the bacteria that cause Neonatal Sepsis or Sepsis in Infants are pseudomonas, staphylococcus aureus, acinetobacter, anaerobes, klebsiella, enterobacter, candida and serratia.
What are the Symptoms of Neonatal Sepsis?
Neonatal Sepsis or Sepsis in Infants tends to have a variety of presenting features. Some of the symptoms of Neonatal Sepsis or Sepsis in Infants are:
- Increased crankiness or irritability
- Decreased tone or floppiness of the tone
- Body temperature alterations
- Reduced body movements
- Reduced sucking
- Low blood sugar
- Difficulty in feeding along with disinterest and vomiting
- Fever over 100.4 degree Fahrenheit
- Difficulty in breathing or breathing too fast
- Skin colour change usually becoming pale, blue or patchy
- Decreased urination
- Swollen belly area
- Bulging or swelling of the soft spot on the infant’s head.
The symptoms of Neonatal Sepsis or Sepsis in Infants are quite distinct and require emergent medical attention and appropriate treatment in order to treat this condition and save the baby’s life as if left untreated it may lead to potentially life threatening complications. In children in the age range of 1-2 years of age, this condition may present in the form of high fever, frequent vomiting, skin rashes, change in skin color, breathing problems, tachycardia, feeling lethargic and weak, irritability and being confused. Sepsis in an older child usually comes as a complication of another condition of which the most common is pneumonia.
How is Neonatal Sepsis or Sepsis in Infants Diagnosed?
If a newborn baby has any of the symptoms as mentioned above then to rule out sepsis a battery of laboratory tests will be done after a complete physical examination and history taking in which the physician will ask the parents as to the duration of the symptoms and whether they have noticed anything else apart from the symptoms and whether the pregnancy period was normal or marred with certain complications predisposing the baby to Neonatal Sepsis or Sepsis in Infants.
In case Neonatal Sepsis or Sepsis in Infants is suspected, the best way to confirm the diagnosis is to isolate the bacteria from the blood stream by taking blood cultures. Apart from this, there is no specific method by which Neonatal Sepsis or Sepsis in Infants can be confirmatively diagnosed. Conventional methods to diagnose Neonatal Sepsis or Sepsis in Infants take about a couple of days to rule in or rule out Neonatal Sepsis or Sepsis in Infants. In some cases the results may also be false positive. Hence to avoid such situations, physicians look for clinical features and observe whether they are at risk for having Neonatal Sepsis or Sepsis in Infants before coming to a conclusion and formulating a treatment plan and coming to a conclusion as to which antibiotic should be used for best results.
Some of the common laboratory tests that are performed to confirm the diagnosis of Neonatal Sepsis or Sepsis in Infants are:
- Urine test for checking the presence of bacteria by inserting a sterile catheter to baby’s bladder through urethra
- Blood tests for checking white blood cell count, C-reactive protein, complete blood count and blood culture and checking the proper functioning of all vital organs
- Lumbar puncture or spinal tap is done for taking a sample of spinal fluid depending on baby’s age and appearance.
- If any infant has any running tube into the body such as catheters or IV tubes, the fluid inside the tubes are also sent for testing for any kind of infection
- X-rays of chest to look for any presence of pneumonia as a potential cause of Neonatal Sepsis or Sepsis in Infants.
How is Neonatal Sepsis or Sepsis in Infants Treated?
Once Neonatal Sepsis or Sepsis in Infants is confirmed, the baby will be started on intravenous antibiotics. The baby will also be kept hydrated by utilizing IV fluids and electrolytes. Some of the medications used for treating Neonatal Sepsis or Sepsis in Infants are:
- Penicillin G
Babies born to mothers who have a condition called chorioamnionitis are given intravenous antibiotics as they are born as a preventive measure even if they may not be showing any signs or symptoms of Neonatal Sepsis or Sepsis in Infants. The course of antibiotics may go up to three weeks in case of bacteria is found on tests. In case if there is no bacteria then this treatment is given for may be just a week or so.
For babies born to mothers who have a history of being exposed to Herpes Simplex Virus then an antiviral like acyclovir may be given to the baby. For children above age of one year who do not show any signs or symptoms of Neonatal Sepsis or Sepsis in Infants but are at risk for developing this condition may be observed closely as an outpatient to make sure that they do not develop this condition and even if they develop they may be treated immediately.
Can Neonatal Sepsis or Sepsis in Infants be Prevented?
There may be no definite way to prevent Neonatal Sepsis or Sepsis in Infants but this condition can definitely be avoided if the mother takes care of herself during pregnancy. This can be done by checking the transmission of GBS bacteria from mother to child during delivery. Pregnant females are recommended to undergo a simple swab test between the 35th and 37th weeks of pregnancy to determine if they are infected with GBS bacteria.
In case if a female is found to be positive for GBS bacteria then she would be given IV antibiotics during her labor period so as to prevent the bacteria from affecting the baby at the time of birth. For optimum results, antibiotic administration to the mother should be started at least four hours before delivery thus it is vital for females with positive GBS bacteria to get admitted to the hospital so that any danger of the child being affected with Neonatal Sepsis or Sepsis in Infants be prevented.
Females who have a fever during labor or their amniotic sac ruptures prematurely are at maximum risk for having positive GBS bacteria. Another preventive measure that can be taken to prevent Neonatal Sepsis or Sepsis in Infants is immunizations and vaccinations which protect the baby from certain types of bacteria that are known to cause Neonatal Sepsis or Sepsis in Infants.
Apart from these measures, one can employ certain lifestyle modifications like washing hands thoroughly before touching the child and making sure that sick people do not get near the child may go a log way in preventing the child from getting affected by Neonatal Sepsis or Sepsis in Infants.