Neonatal sepsis is a frequent cause of neonatal mortality; unfortunately, the symptoms of sepsis are not specific and may be attributed to other, noninfectious, causes. It is, therefore, crucial to pay attention to the risk factors for neonatal sepsis.

For early-onset infections, the maternal status of colonization by microorganisms and associated factors are the most important predictors of sepsis in neonates. Infection by group B streptococcus (GBS) species is the most frequent cause of neonatal sepsis, although the prophylactic antibiotic administration has decreased its incidence. Escherichia coli is another common cause of early-onset infections, followed in frequency by other organisms, such as haemophilus influenzae. Organisms such as GBS can invade the amniotic fluid during labor or through occult tears, and cause chorioamnionitis. Women with premature rupture of membranes are also at high risk for colonization of the amniotic fluid, as are those who have preterm labor. All of the above factors can suggest risk for sepsis in the newborn [1] [2]. In one study, women in preterm labor and with premature rupture of membranes were found to have a 75% incidence of microbial invasion of the amniotic cavity [3].

The most important risk factor for late-onset sepsis is the gestational age at delivery: premature newborns are at increased risk because of a weak immune system, or procedures utilizing invasive devices. The most common agent of late-onset sepsis is the group of coagulase-negative staphylococci, major nosocomial pathogens.

Initial signs of neonatal sepsis include decreased activity, feeding and breathing difficulties, abnormal temperature (too high or too low), and diarrhea or vomiting. Hypoglycemia, hyperglycemia, and metabolic acidosis often accompany sepsis, but also occur in purely metabolic conditions. Pneumonia, whether of intrauterine or intrapartum origin, may not be easy to differentiate from respiratory distress syndrome. Coughing, irregular respiration, decreased breath sounds and other symptoms characterize both diseases. Neurological signs (changes in consciousness, seizures, and others) are characteristic of meningitis, which is the common form of central nervous system infection in neonatal sepsis.

• Sepsis

  […] tion (early onset sepsis, late onset sepsis). [paediatricaindonesiana.org]

  Svenska synonymer Sepsis, neonatal — Sepsis hos nyfödda Engelska synonymer Neonatal Sepses — Sepses, Neonatal — Sepsis, Neonatal — Neonatal Late-Onset Sepsis — Late-Onset Sepses, Neonatal — Late-Onset Sepsis, Neonatal — Neonatal Late Onset Sepsis — Neonatal [mesh.kib.ki.se]

  Neonatal sepsis is divided into two categories: early-onset sepsis (EOS) and late-onset sepsis (LOS). [en.wikipedia.org]

  Neonatal sepsis can be classified into two major categories – early-onset sepsis (EOS) and late-onset sepsis (LOS), depending on the timing of onset of signs/symptoms. The definitions of EOS and LOS vary. [dovepress.com]

  Sepsis neonatorum, or neonatal sepsis, is an invasive infection that occurs in newborns. [symptoma.com]

• Fever

  Risk Factors: Early onset Sepsis Major Maternal prolonged Rupture of Membranes >18-24 hours Intrapartum maternal fever >38 C (>100.4 F) Chorioamnionitis Sustained Fetal Tachycardia >160 beats per minute Minor Intrapartum maternal fever >37.5 C (>99.5 [fpnotebook.com]

  Fever or frequent changes in temperature Breathing rapidly, difficulty breathing, or periods of no breathing (apnea) Poor feeding from breast or bottle Decreased or absent urination Bloated abdomen Vomiting yellowish material Diarrhea Extreme redness [lahey.org]

• Inflammation

  Tissues remote from the original insult display the signs of inflammation, including vasodilation, increased microvascular permeability, and leukocyte accumulation. [accesspediatrics.mhmedical.com]

  Those neonates with the most severe placental inflammation survived while all of those who died had moderate or only mild chorioamnionitis. Acute villitis was noted in the placentas of three neonates who died. [jamanetwork.com]

• Asymptomatic

  The LP can be deferred for asymptomatic infants. [cps.ca]

  Infections specific to the perinatal period (P35-P39) Includes: infections acquired in utero or during birth Excludes: asymptomatic human immunodeficiency virus [HIV] infection status ( Z21 ) congenital: · gonococcal infection ( A54.- ) · pneumonia [apps.who.int]

  Clinical signs inderteminate signs lethargy, irratability hypothermia or hyperthermia respiratory distress feeding disturbances mild jaundice seizures apnea Etiology Gram-positive group βhemolytic Streptococcus group B  —  asymptomatic vaginal colonization [atlases.muni.cz]

  Early-onset neonatal sepsis is a result of asymptomatic colonization in the intestinal or genital tract of the mother. Colonization is the existence of bacteria/viruses in a body part. [buzzle.com]

• Weakness

  Assessment Patient may manifest Irritability Weakness Temperature above normal level (36 oC) Skin warm to touch Presence of tachycardia (above 160 bpm) Presence of tachypnea (above 60 bpm) WBC elevated Nursing Diagnosis Hyperthermia related to inflammatory [rnpedia.com]

  Infants with neonatal sepsis or infection may exhibit some of these symptoms: apnea shock diarrhea seizures jaundice vomiting cyanosis irritability skin rashes nasal flaring weak sucking rapid breathing low blood sugar slowed heart rate lethargic, inactive [healthblurbs.com]

  The most important risk factor for late-onset sepsis is the gestational age at delivery: premature newborns are at increased risk because of a weak immune system, or procedures utilizing invasive devices. [symptoma.com]

  Regarding the clinical presentation, we found that the most common clinical findings among patients with sepsis were weak sucking in 93.3% of the cases, followed by weak Moro in 70% of the cases. [mmj.eg.net]

  A weak immune system is unable to isolate the infection, allowing it to spread to other organs and tissues. This overwhelms the immune system and inflammation sets in all over the body. [news-medical.net]

• Pneumonia

  Full Text Dear Editor, Streptococcus pneumoniae (pneumococcus) is a microorganism with high morbidity in children, especially when related with the respiratory tract (in the form of pneumonia) and as a focus of infection in the otorhinolaryngological [archbronconeumol.org]

  Both organisms produce diseases with many features in common, especially fulminant courses with respiratory distress and pneumonia, and often have a fatal outcome. ( AJDC 1986;140:117-121) [jamanetwork.com]

  Among positive cases, the bacteriological profile was found highest for Staphylococcus aureus (35.6%) followed by Klebsiella pneumoniae (15.3%). [bmcresnotes.biomedcentral.com]

  (Ampi + Amika + Cefo ) (Ampi + Amika + Cefo ) ampicillin - gentamicin ) 17 late-onset disease ( community acquired) neonatal pathogens of early onset potential community acquired pathogens S. pneumoniae,N.meningitidis & H.influenza. [slideplayer.com]

• Abdominal Distension

  The patient had no history of hematemesis, jaundice, abdominal distension or abdominal pain. There was no family history for coagulation disorders. At admission the complete blood count was normal and the inflammatory markers were negative. [termedia.pl]

  Hepatomegaly, splenomegaly, abdominal distension. Hypothermia, hyperthermia. Exclusion criteria Babies with the following signs and symptoms: Congenital infection. Early neonatal sepsis. Perinatal asphyxia. Congenital anomalies. [mmj.eg.net]

  distension Splenomegaly Neurologic Convulsions Hypotonia and Hypodynamia Lethargy [ 12 ] Symptoms of Cardiovascular and Skin Disorders: Cardiovascular: Hypotension Metabolic Acidosis Tachycardia Skin: Pale or marble with petechia or purple Mottling Cold [intechopen.com]

  Gastrointestinal (GIT) symptoms poor feeding vomiting abdominal distension feed intolerance bilious aspirates/vomits loose stools. Central nervous system (CNS) symptoms lethargy irritability seizures. [www2.health.vic.gov.au]

• Failure to Thrive

  Children develope failure to thrive, developemental dalay, anemia, oral thrush, chronic diarrhea. Reccurent bacterial infections and opportunistic infections occur (Pnemocystis carinii). [atlases.muni.cz]

• Tachycardia

  Risk Factors: Early onset Sepsis Major Maternal prolonged Rupture of Membranes >18-24 hours Intrapartum maternal fever >38 C (>100.4 F) Chorioamnionitis Sustained Fetal Tachycardia >160 beats per minute Minor Intrapartum maternal fever >37.5 C (>99.5 [fpnotebook.com]

  Assessment Patient may manifest Irritability Weakness Temperature above normal level (36 oC) Skin warm to touch Presence of tachycardia (above 160 bpm) Presence of tachypnea (above 60 bpm) WBC elevated Nursing Diagnosis Hyperthermia related to inflammatory [rnpedia.com]

  The child showed extreme hemodynamic instability (with bursts of his paroxysmal supraventricular tachycardia (heart rate >250beats/min) alternate to bradycardia (heart rate He rapidly developed oligoanuria and was not responsive to furosemide. [karger.com]

• Hypotension

  […] sepsis is suspected; Instability of body temperature; Gastro-intestinal symptoms (vomiting, abdominal distension, blood in stool, increase in quantity of residual mass in stomach); Neurological symptoms; Cardiorespiratory dysfunction (100 180, 30 60, hypotension [intechopen.com]

  Treating Hypotension in Preterm Neonates With Vasoactive Medications. NCBI. Retrieved September 12, 2022. Wynn, J. L., & Wong, H. R. (2011, June 01). Pathophysiology and Treatment of Septic Shock in Neonates. Clinical Perinatology, 37(2), 439-479. [nurseslabs.com]

  Diarrhea Abdominal Distention Ileus Dehydration signs with poor feeding Splenomegaly Neurologic Activity decreased or lethargy Irritability Tremor, jitteriness or Seizure Hyporeflexia or hypotonia High pitched cry Swelling of Fontanel Cardiovascular Hypotension [fpnotebook.com]

• Hypertension

  The natural history of PVT results in portal hypertension leading to splenomegaly and formation of portosystemic collateral blood vessels and esophageal, gastric, duodenal, and jejunal varices [3]. [termedia.pl]

  A toxin derived from the polysaccharide capsule of type III Streptococcus has also been shown to cause pulmonary hypertension. [emedicine.medscape.com]

  […] long term sequelae of prematurity + Viability + Survivability in prematurity + Severe long term sequelae in babies born prematurely + Birth asphyxia + Hypoxic-ischemic encephalopathy (HIE) + Meconium aspiration syndrome (MAS) + Persistent pulmonary hypertension [atlases.muni.cz]

  Labor was induced because of late-term maternal hypertension. The mother received antibiotics during labor and delivery was by emergent cesarean section for fetal bradycardia. [pediatriceducation.org]

  NonHodgkins Lymphoma 476 Malignant Bone Tumors 477 Malignant Brain Tumors 479 Wilms Tumor 481 Neuroblastoma 482 Retinoblastoma 484 Histiocytic Proliferative Diseases 485 Genitourinary System 486 Enuresis 487 Glomerulonephritis 490 Nephrotic Syndrome 495 Hypertension [books.google.de]

• Heart Failure

  […] in the infant [17] Congenital pneumonia Congestive heart failure Newborn hemolytic disease Congenital diaphragmatic hernia Respiratory distress syndrome Necrotizing enterocolitis Bacterial pericarditis [17] Meconium aspiration syndrome Pulmonary hypoplasia [pregmed.org]

  Prompt treatment means people are more likely to survive and it reduces the risk of further problems like heart failure or limb amputation. Think sepsis Sepsis can be difficult to diagnose as symptoms can vary from person to person. [indepth.nice.org.uk]

  […] disease 0 (0) 0 (0) 3 (5.3) 0 (0) 0 (0) 32 (4.1) Acyanotic CHD with heart failure 0 (0) 1 (2.8) 3 (5.3) 0 (0) 0 (0) 17 (2.2) Bronchopulmonary dysplasia 9 (17.6) 23 (63.9)** 15 (26.3) 6 (28.6) 2 (28.6) 243 (31.1) Pulmonary hypertension 1 (2.0) 1 (2.8) [bmcinfectdis.biomedcentral.com]

• Neonatal Jaundice

  The distribution of 70 respondents obtained as much 15 neonates have history neonatal sepsis of which 12 neonatal jaundice and 3 not became neonatal jaundice. [eprints.ums.ac.id]

  Jaundice in the newborn breastfed babies. Pathological neonatal jaundice can be caused by a number of factors, including: blood group incompatibility;... [evidence.nhs.uk]

  In the current study we did not find UTI among jaundiced neonates aged 5 days and younger. UTI was detected among 24 neonates who presented with jaundice between 5–7 days of age. [ijp.mums.ac.ir]

  However, there are concerns about high resistance rates, and side effects such as neonatal jaundice have been reported [71]. [journals.plos.org]

• Oliguria

  Other clinical features include oliguria (low urine output) persisting more than 24 hours after birth, altered glucose homeostasis (low or high blood sugar levels), metabolic acidosis, local signs of infection, diarrhoea and vomiting, hypothermia, lethargy [jfhc.co.uk]

  Extremely severe metabolic acidosis, disseminated intravascular coagulation (DIC) with diffuse bleeding, and unstable hemodynamic status with oliguria turned into strict anuria, and the patient became anuric. [karger.com]

• Lethargy

  Random effects meta-analysis showed that lethargy, pallor/mottling, total parenteral nutrition, lipid infusion, and postnatal corticosteroids were predictive for HABSI. [pediatrics.aappublications.org]

  2Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Correspondence to TA Hooven thomas.hooven{at}chp.edu What you need to know The most common early signs of sepsis in infants are fever or hypothermia, tachypnoea, lethargy [bmj.com]

  Clinical signs inderteminate signs lethargy, irratability hypothermia or hyperthermia respiratory distress feeding disturbances mild jaundice seizures apnea Etiology Gram-positive group βhemolytic Streptococcus group B  —  asymptomatic vaginal colonization [atlases.muni.cz]

  Bradycardia (slow heart rate) Tachycardia (increased heart rate) Temperature instability Low blood pressure Neurological changes : Irritability, lethargy, and non-responsiveness Low urine output Lethargy and hypotonia (decreased muscle tone) Meningitis [michigancerebralpalsyattorneys.com]

  Weak sucking was the most frequent clinical finding (93%), followed by weak Moro (70%) and lethargy (53.3%). Of the neonates in our study, 48 cases were positive for the hematological sepsis score and 12 were negative. [mmj.eg.net]

• Febrile Seizures

  677 Slipped Capital Femoral Epiphysis 679 Femoral Anteversion 680 Patellofemoral Problems 682 OsgoodSchlatter Disease 683 Blounts Disease 684 Genu Valgum 685 Metatarsus Adductus 686 Clubfoot 687 Scoliosis 689 Kyphosis 692 Cervical Spine Problems 693 Febrile [books.google.de]

Early diagnosis is critical for starting therapy. The pathogen should be identified as soon as possible, so that the treatment with broad-spectrum antibiotics, which carries potential risks if continued too long, can be replaced by a regimen using more specific agents. Analysis of the complete blood cell count with differentials, together with cultures of blood, cerebrospinal fluid and urine (the latter only for late-onset sepsis) are performed in suspected cases.

Thrombocytopenia [4] and neutropenia [5] are frequently observed but are not specific signs. The immature to total neutrophil ratio is a more sensitive indicator of sepsis [5]. Sepsis screening panels use a variety of indicators, including leukocyte counts, neutrophil counts and immature to total neutrophil ratios [6]; their positive predictive value is highly diagnostic.

Blood cultures should test for both aerobic and anaerobic bacteria; growth usually occurs within two days. Results from tests using the polymerase chain reaction (PCR) are available in five hours [7]. Testing for herpes simplex virus is also done by PCR in cases where there is a strong indication of infection by the virus.

Of the acute phase proteins, C-reactive protein and procalcitonin have been used most extensively [8] [9]. A raised procalcitonin level 24 hours after birth is a good indicator of sepsis [10].

Analysis of the cerebrospinal fluid shows increased protein concentration and white blood cell count and decreased glucose concentration in case of meningitis. Cerebrospinal fluid culture should be obtained in cases of suspected sepsis if lumbar puncture can be performed. If the culture shows bacterial growth, further samples should be taken to follow the course of the disease and the effectiveness of treatment.

Chest radiography and imaging of the head by computed tomographic scan, magnetic resonance imaging, or ultrasonography are performed as needed.

[…] for neonatal sepsis but not to prolong treatment unnecessarily. [journals.lww.com]

[…] of drug-resistance to the current WHO recommended treatment regimen (ampicillin and gentamicin). [gardp.org]

In some units, 48-hourly LPs are performed in cases of Gram-negative meningitis, with treatment continuing for 14 days after the first negative culture - in practice this usually equates with a 21-day treatment course. [www2.health.vic.gov.au]

Treatment / Management Empiric treatment with antibiotics should be started as soon as sepsis is clinically suspected, even without confirmatory lab data. [ncbi.nlm.nih.gov]

The more quickly an infant gets treatment, the better the outcome. [pennstatehershey.adam.com]

The prognosis for babies with bacterial infections is quite good. Most newborns will recover quickly from the infection as soon as proper medication begins. [news-medical.net]

Prognosis and Treatment Sepsis in a newborn is treated with antibiotics given intravenously. Treatment is started even before laboratory results are available; a different antibiotic may later be chosen based on the results of laboratory tests. [hon.ch]

Expectations (prognosis) With prompt treatment, many babies with these bacterial infections will recover completely with no remaining problems. Nevertheless, neonatal sepsis is a leading cause of infant death. [coordinatedhealth.com]

Outlook (Prognosis) Many babies with bacterial infections will recover completely and have no other problems. However, neonatal sepsis is a leading cause of infant death. The more quickly an infant gets treatment, the better the outcome. [ufhealth.org]

Prognosis and Treatment Sepsis in a newborn is treated with antibiotics given intravenously. Antibiotics are often started even before laboratory and culture results are available. [rchsd.org]

IGBS is associated with both early and late onset sepsis and the most common etiologic agent of neonatal meningitis. [atlases.muni.cz]

There is a clear need for investment in expanded surveillance activities and in more research on diagnosis, etiology, and treatment of neonatal sepsis at all levels of the health system, and especially at the community level. [who.int]

Early-Onset Infection Prior to the 1970s, staphylococci and gram-negative rod species were the predominant etiologic agents of neonatal sepsis. [obgynkey.com]

Abstract Although sepsis is one of the important etiologies of illness in hospitalized infants, it is often difficult to determine if an infant is truly infected and, moreover, how to treat these infections. [neoreviews.aappublications.org]

Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51(RR–16):1–45, quiz CE1–4. 30. [dovepress.com]

Baker, Changing epidemiology of group B Streptococcal colonization, 1999 8. Noormanto, Antibiotika profilaktik pada neonatus dengan ketuban pecah dini, uji klinis terkendali acak, 1995 9. R.A. Watase, K.Y. Hirata, T.S. [i-lib.ugm.ac.id]

Bernhard Resch, MD Division of Neonatology Department of Pediatrics Research Unit for Neonatal Infectious Diseases and Epidemiology Silvia Edlinger, MD Research Unit for Neonatal Infectious Diseases and Epidemiology Wilhelm Müller, MD Division of Neonatology [journals.lww.com]

Centers for Disease Control and Prevention investigators have studied the changing epidemiology of invasive EOS for several decades. [pediatrics.aappublications.org]

An epidemiological survey of neonatal sepsis in a hospital in Western Nigeria. African Journal of Microbiology Research. 2009;3:385-9. 8. Rohsiswatmo R.K ontroversi diagnosis sepsis neonatorum. In: Hegar B, Trihono Pp, Ifran EB, editors. [paediatricaindonesiana.org]

[…] use of instrumentation, such as forceps, or placement of electrodes for intrauterine monitoring during labor and delivery.6 Black race is a risk factor for both early- and late-onset GBS sepsis, and the reasons behind this are not fully understood.7 PATHOPHYSIOLOGY [accesspediatrics.mhmedical.com]

Pathophysiology and Treatment of Septic Shock in Neonates. Clinical Perinatology, 37(2), 439-479. [nurseslabs.com]

[…] organisms like Coagulase-negative Staphylococcus, Staphylococcus aureus, E.coli and GBS, risk factors for late-onset neonatal sepsis include: Extended use of catheter during pregnancy [7] Extended hospital stay after the baby is born [8] Neonatal Sepsis Pathophysiology [pregmed.org]

[…] and prevent health care-associated MRSA transmission in Japanese NICUs Note: Reproduced with permission from John Wiley and Sons. [dovepress.com]

Prevention Pregnant women may need preventive antibiotics if they have: Chorioamnionitis Group B strep colonization Given birth in the past to a baby with sepsis caused by bacteria Other things that can help prevent sepsis include: Preventing and treating [ufhealth.org]

Wandita - Evaluation of prophylactic antibiotics to prevent early - onset clinical neonatal sepsis in newborn with potential infection. [i-lib.ugm.ac.id]

Breastfeeding may also help prevent sepsis in some infants. Follow steps to prevent premature labor or birth. This can include proper prenatal care, avoiding drugs and alcohol, and eating a healthy balanced diet. [winchesterhospital.org]

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7. Chan KY, Lam HS, Cheung HM, et al. Rapid identification and differentiation of Gram-negative and Gram-positive bacterial bloodstream infections by quantitative polymerase chain reaction in preterm infants. Crit Care Med. 2009 Aug. 37(8):2441-2447.
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10. Altunhan H, Annagür A, Örs R, Mehmetoglu I. Procalcitonin measurement at 24 hours of age may be helpful in the prompt diagnosis of early-onset neonatal sepsis. Int J Infect Dis. 2011 Dec. 15(12):e854-458.