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.

• 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]

  Infants rarely present with fever unless born to a febrile mother, although some acquire fever immediately after delivery. It is more common for an infant to be hypothermic or present with pneumonia, two nonspecific signs of sepsis. [arupconsult.com]

• Cerebral Palsy

  Brain damage Cognitive impairments Cerebral palsy Edema (fluid buildup in the brain) Brain abscesses (pus-filled pockets) Cerebral palsy Developmental delays Seizure disorders Learning disabilities What Are the Signs and Symptoms of Neonatal Sepsis and [michigancerebralpalsyattorneys.com]

  Chorioamnionitis as a risk factor for cerebral palsy: A meta-analysis. [scielo.br]

  Antenatal, Intra Partum, and Neonatal Risk Factor for Cerebral Palsy in Children in Podlaskie Province. Journal of Polish Society of Child Neurology. 2009; 18: 19-24. Schlapbach LJ, Aebischer M, Adams M, et al. [jkb.ub.ac.id]

  Neonatal risk factors for cerebral palsy in very preterm babies: case-control study. BMJ 1997 ;314: 404 - 408 3. Stoll BJ, Hansen NI, Adams-Chapman I, et al. [nejm.org]

• Pallor

  One study, 56 which included all neonates, could not find a significant association between pallor and sepsis. Another multicenter study, 45 which also included all neonates, clustered pallor and/or mottling under impaired peripheral perfusion. [pediatrics.aappublications.org]

  […] 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 Metabolic Acidosis Tachycardia Skin Pallor [fpnotebook.com]

  General features of neonatal sepsis Pallor, lethargy, jaundice Fever, hypothermia, temperature instability. Note: One-third of confirmed sepsis cases are normothermic. [www2.health.vic.gov.au]

• 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]

  Abstract Infections (including sepsis, meningitis, pneumonia and tetanus) stand as a major contributor to neonatal mortality in Haiti (22%). [tropej.oxfordjournals.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]

• Decreased Breath Sounds

  Coughing, irregular respiration, decreased breath sounds and other symptoms characterize both diseases. [symptoma.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]

• 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]

• 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]

  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]

  Cardiovascular system symptoms tachycardia bradycardic episodes poor perfusion hypotension. Cutaneous symptoms petechiae bruising bleeding from puncture sites. [www2.health.vic.gov.au]

• Cardiomegaly

  Imaging Chest XRay Indicated in all cases Evaluate for Pneumonia, cardiomegaly, Pneumothorax Other imaging indicated in specific scenarios CT Head Indicated for suspected Head Trauma Subdural Hematoma may present with findings suggestive of Neonatal Sepsis [fpnotebook.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]

• Scissoring Gait

  Among those who walked independently, atypical patterns were observed in ten cases: hemiplegic gait (n = 3), unsteady gait and an increase in the support polygon (n = 3), valgus feet (n = 2), digitigrade gait (n = 1), and scissor gait (n = 1). reeling [scielo.br]

• Visual Impairment

  Previous studies have suggested that infants with signs of sepsis were more likely to have cerebral palsy, lower cognitive and motor scores, and visual impairment. 14 In this study, the particular involvement of Gram-positive infection, which presented [scielo.br]

• Type A Personality

  This lesson explores the various types, definitions, and causes of neonatal sepsis. In addition, a brief overview of risk-factors associated with sepsis will be explored. Neonatal Sepsis Sepsis is not exclusive to one type of person or problem. [study.com]

• 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.

• Hyponatremia

  […] herpes simplex Pertussis Congenital syphilis Cardiac Disease Congenital heartdisease Supraventricular tachycardia Myocardial infarction Pericarditis Myocarditis Kawasaki disease Endocrine Disorders Congenital adrenal hyperplasia Metabolic Disorders Hyponatremia [obgynkey.com]

• T Wave Inversion

  Diagnostics: Electrocardiogram (EKG) Indications Tachycardia Cardiac ausultation findings (e.g. cardiac murmur, gallup, rub) Hepatosplenomegaly Technique Consider obtaing EKG at half speed for easier interpretation Expect T Wave inversion in leads V1 [fpnotebook.com]

• White Matter Lesions

  White matter injury can be frequently visualized with cranial ultrasonography or MRI in the form of increased echogenicity in the periventricular white matter of neonates with encephalitis due to HPeV, similar to lesions seen, albeit less frequently, [cmr.asm.org]

• Abnormal Amniotic Fluid

  amniotic fluid, placental abnormalities, the emergence of respiratory disease, and the requirement of any medical procedure (Table 3 ). [bmcpregnancychildbirth.biomedcentral.com]

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

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

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]

The child affected by this medical condition should be given treatment at the earliest. [healthhearty.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]

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]

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]

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]

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]

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]

Etiology and epidemiology Etiological Structure of Sepsis in Developed Countries Figure 3. J. [intechopen.com]

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]

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]

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]

An up-to-date and thorough understanding of the epidemiology and management of neonatal LOS may help to reduce the burden of this disease. [fn.bmj.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]

Neonatology Pathophysiology and Management of the Newborn. Philadelphia: Lippincott Company; 2005. p. 1235–75. Stoll B. Infections of the neonatal infant. In: Kliegman R, Behrman RE, Jenson HB, Stanton BF, editor. Nelson textbook of pediatrics. [e-journal.unair.ac.id]

Overgrowth of these organisms in the neonatal lumen can be a component of the multifactorial pathophysiology of necrotizing enterocolitis. [emedicine.medscape.com]

Maternal immunization against invasive pathogens could prevent disease in the triad of mother, fetus, and newborn, a worthy goal. 14 GBS immunization would prevent both early- and late-onset neonatal disease and might have an impact on other adverse outcomes [pediatrics.aappublications.org]

prevention of infections in very premature babies (LACUNA), ISRCTN66482337; oral lactoferrin supplementation for prevention of sepsis in preterm neonate, NCT01821989; Enteral Lactoferrin In Neonates (ELFIN), ISRCTN88261002 [ 4 ]. [omicsgroup.org]

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]

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

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