Sepsis

Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs. In neonates, sepsis is a critical concern due to their immature immune systems and the high risk of rapid progression to severe illness.

Causes

Neonatal sepsis can be caused by various pathogens, including bacteria, viruses, fungi, and parasites. The most common pathogens include:

  • Bacteria: Group B Streptococcus (GBS), Escherichia coli (E. coli), Listeria monocytogenes, Klebsiella, and Staphylococcus aureus.
  • Viruses: Herpes simplex virus (HSV), enteroviruses, and respiratory syncytial virus (RSV).
  • Fungi: Candida species.

Types

  1. Early-Onset Sepsis (EOS): Occurs within the first 72 hours of life, typically caused by bacteria acquired from the mother during delivery.
  2. Late-Onset Sepsis (LOS): Occurs after 72 hours of life and can be acquired from the environment or through invasive procedures.

Risk Factors

  • Premature birth: Premature infants have less developed immune systems.
  • Prolonged rupture of membranes: Increases the risk of bacterial infection.
  • Maternal infection: Infections in the mother can be transmitted to the baby.
  • Invasive procedures: Such as catheterization or intubation.

Symptoms

  • Fever or hypothermia
  • Lethargy or irritability
  • Poor feeding
  • Respiratory distress (grunting, flaring, retractions)
  • Apnea (pauses in breathing)
  • Bradycardia (slow heart rate)
  • Hypotension (low blood pressure)
  • Jaundice
  • Seizures

Diagnosis

  • Blood cultures: To identify the causative organism.
  • Lumbar puncture: To check for meningitis.
  • Urine cultures: To detect urinary tract infections.
  • Chest X-ray: To identify pneumonia.
  • Laboratory tests: CBC, CRP, procalcitonin, and other markers of infection and inflammation.

Treatment

  • Empirical Antibiotic Therapy: Broad-spectrum antibiotics are started immediately after obtaining cultures and can be adjusted based on culture results.
    • Common antibiotics: Ampicillin, gentamicin, cefotaxime, or vancomycin.
  • Supportive Care: Includes intravenous fluids, oxygen therapy, mechanical ventilation if necessary, and monitoring and managing blood pressure and organ function.

Prevention

  • Maternal Screening: Testing and treating maternal infections during pregnancy.
  • Intrapartum Antibiotic Prophylaxis: Administered to mothers at risk of transmitting GBS during delivery.
  • Sterile Techniques: Proper hygiene and sterile techniques in neonatal care units to prevent nosocomial infections.
  • Breastfeeding: Provides antibodies and nutrients that help protect against infections.

Early recognition and prompt treatment of neonatal sepsis are crucial for reducing mortality and morbidity. Continuous monitoring and supportive care in a neonatal intensive care unit (NICU) may be required for severe cases.