Neonatal sepsis is the single most common cause of neonatal death in hospital as well as community in developing country. It is difficult to clinically exclude sepsis in newborns less than 90 days old that have fever (defined as a temperature > 38 °C (100.4 °F).
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- Signs and Symptoms
- Risk Factors
The signs of sepsis are non-specific and include: 1. Body temperature changes 2. Breathing problems 3. Diarrhea 4. Low blood sugar (hypoglycemia) 5. Reduced movements 6. Reduced sucking 7. Seizures 8. Bradycardia 9. Swollen belly area 10. Vomiting 11. Yellow skin and whites of the eyes (jaundice). 12. hemorrhagic rash A heart rate above 160 can also be an indicator of sepsis, this tachycardia can present up to 24 hours before the onset of other signs.
A study performed at Strong Memorial Hospital in Rochester, New York, showed that infants ≤ 60 days old meeting the following criteria were at low-risk for having a serious bacterial illness: 1. generally well-appearing 2. previously healthy 2.1. full term (at ≥37 weeks gestation) 2.2. no antibiotics perinatally 2.3. no unexplained hyperbilirubinemia that required treatment 2.4. no antibiotics since discharge 2.5. no hospitalizations 2.6. no chronic illness 2.7. discharged at the same time or before the mother 3. no evidence of skin, soft tissue, bone, joint, or ear infection 4. White blood cells (WBCs) count 5,000-15,000/mm3 5. absolute band count ≤ 1,500/mm3 6. urine WBC count ≤ 10 per high power field (hpf) 7. stool WBC count ≤ 5 per high power field (hpf) only in infants with diarrhea Those meeting these criteria likely do not require a lumbar puncture, and are felt to be safe for discharge home without antibiotic treatment, or with a single dose of...
Neonatal sepsis screening: 1. DLC (differential leukocyte count) showing increased numbers of polymorphs. 2. DLC: band cells > 20%. 3. increased haptoglobins. 4. micro ESR (erythrocyte sedimentation rate) titer > 15mm. 5. gastric aspirate showing > 5 polymorphs per high power field. 6. newborn CSF (cerebrospinal fluid) screen: showing increased cells and proteins. 7. suggestive history of chorioamnionitis, PROM (premature rupture of membranes), etc... Culturing for microorganisms from a sample of CSF, blood or urine, is the gold standard test for definitive diagnosis of neonatal sepsis. This can give false negatives due to the low sensitivity of culture methods and because of concomitant antibiotic therapy. Lumbar punctures should be done when possible as 10-15% presenting with sepsis also have meningitis, which warrants an antibiotic with a high CSF penetration. CRP is not very accurate in picking up cases.
Note that, in neonates, sepsis is difficult to diagnose clinically. They may be relatively asymptomatic until hemodynamic and respiratory collapse is imminent, so, if there is even a remote suspicion of sepsis, they are frequently treated with antibiotics empirically until cultures are sufficiently proven to be negative. In addition to fluid resuscitation and supportive care, a common antibiotic regimen in infants with suspected sepsis is a beta-lactam antibiotic (usually ampicillin) in combination with an aminoglycoside (usually gentamicin) or a third-generation cephalosporin (usually cefotaxime—ceftriaxone is generally avoided in neonates due to the theoretical risk of kernicterus.) The organisms which are targeted are species that predominate in the female genitourinary tract and to which neonates are especially vulnerable to, specifically Group B Streptococcus, Escherichia coli,...
Since the 1990s early-onset sepsis has declined because of screening of group B streptococcus. The cause of early-onset neonatal sepsis are pathogens that contaminate the placenta, vaginal canal, cervix, or amniotic fluid, and these pathogens can affect the baby either in the womb or during labor. Early-onset neonatal sepsis is found to be 0.77 to 1 per 100,000 live births in the U.S. In premature babies, the incidence and mortality rates are higher due to the weakness of their immune system. For infants with low birth weight, cases of early-onset sepsis is found to be about 26 per 1,000 and 8 per 1,000 live births. Certain populations of babies are at more risk as well. Mothers who have poor healthcare, low socioeconomic status, substance abuse, or are African American have higher rates of neonatal sepsis. In fact, African American preterm babies have the highest rate of infection and mortality. 5.14 of every 1,000 live...
Trials of probiotics for prevention of neonatal sepsis have generally been too small and statistically underpowered to detect any benefit, but a randomized controlled trial that enrolled 4,556 neonates in India reported that probiotics significantly reduced the risk of developing sepsis. The probiotic used in the trial was Lactobacillus plantarum. A very large meta-analysis investigated the effect of probiotics on preventing late-onset sepsis (LOS) in neonates. Probiotics were found to reduce the risk of LOS, but only in babies who were fed human milk exclusively. It is difficult to distinguish if the prevention was a result of the probiotic supplementation or if it was a result of the properties of human milk. It is also still unclear if probiotic administration reduces LOS risk in extremely low birth weight infants due to the limited number of studies that investigated it. Out of the 37 studies in...
Neonatal sepsis. In common clinical usage, neonatal sepsis refers to a bacterial blood stream infection in the first month of life, such as meningitis, pneumonia, pyelonephritis, or gastroenteritis, but neonatal sepsis also may be due to infection with fungi, viruses, or parasites.
Talk:Neonatal sepsis. Ideal sources for Wikipedia's health content are defined in the guideline Wikipedia:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Neonatal sepsis. The TRIP database provides clinical publications about evidence-based medicine.
Neonatal Sepsis. Neonatal sepsis is a blood infection that occurs during the first 90 days of an infant’s life. It is especially common in preterm, low-birth-weight babies. It can be caused by bacteria or virus, most commonly Group B streptococcus but most dangerous when caused by E. coli. Symptoms are difficult to identify, but typically ...
A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. Neonatal refers to the first 28 days of life. Neonatal care, as known as specialized nurseries or intensive care, has been around since the 1960s.
Probability of Neonatal Early-Onset Sepsis Based on Maternal Risk Factors and the Infant's Clinical Presentation. The tool below is intended for the use of clinicians trained and experienced in the care of newborn infants. Using this tool, the risk of early-onset sepsis can be calculated in an infant born > 34 weeks gestation. The interactive ...