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Sepsis Neonatorum

Sepsis Neonatal

Sepsis neonatorum, or neonatal sepsis, is an invasive infection that occurs in newborns. Two classes of the disease are distinguished: early-onset sepsis, which usually strikes within the first 24 hours after birth, and late-onset sepsis, which occurs after the fourth day of life. While the organisms causing the infection in the early-onset disease are obtained from the mother, often at the time of passing through the birth canal, the microbes responsible for late-onset sepsis are picked up from the external environment, which is often the hospital.


Presentation

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
  • 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]
  • Females who have a fever during labor or their amniotic sac ruptures prematurely are at maximum risk for having positive GBS bacteria.[epainassist.com]
Cerebral Palsy
  • 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]
  • Sepsis associated with meningitis may lead to the following complications [21] : Cerebral palsy Developmental delay Hearing loss Seizures Neonatal Sepsis Incidence Statistics It is considered an uncommon condition, occurring in 2 to 4 out of every 1000[pregmed.org]
  • 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]
Pediatric Disorder
  • Data Cues list assessment data to help you recognize possible pediatric disorders.[books.google.de]
High-Pitched Cry
  • pitched cry Swelling of Fontanel Cardiovascular Hypotension Metabolic Acidosis Tachycardia Skin Pallor or skin mottling Petechiae or Purpura Cold or clammy skin Cyanosis Jaundice XI.[fpnotebook.com]
Weight Loss
  • His mother reported weight loss of 1 kg in the last month, but the child continued to feed regularly, without rejection of particular foods.[termedia.pl]
Decreased Breath Sounds
  • Coughing, irregular respiration, decreased breath sounds and other symptoms characterize both diseases.[symptoma.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]
  • Pathological neonatal jaundice can be caused by a number of factors, including: blood group incompatibility;...[evidence.nhs.uk]
  • Late diagnosis of neonatal jaundice both increases the severity and complication.[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]
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 F) Twin[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]
  • […] chorioamnionitis; premature rupture of membranes; prolonged rupture of membranes of more than 18 hours, with the risk of sepsis increasing with the duration of rupture prior to delivery; maternal intrapartum temperature of higher than 38 C; sustained fetal tachycardia[obgynkey.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]
  • 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]
  • Exchange transfusions have been used for severely ill (particularly hypotensive and metabolically acidotic) neonates.[msdmanuals.com]
Tremor
  • […] hour (30%) Newborn Temperature 97 F (36 C) Newborn Temperature 99.6 F (37 C) Gastrointestinal symptoms Vomiting Diarrhea Abdominal Distention Ileus Dehydration signs with poor feeding Splenomegaly Neurologic Activity decreased or lethargy Irritability Tremor[fpnotebook.com]

Workup

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.

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]

Treatment

  • […] 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]
  • Antibiotic treatment is commenced immediately if bacteria is the suspected cause of your baby’s infection. With prompt sepsis treatment, many newborns completely recover from bacteria caused infection.[healthblurbs.com]
  • More treatment-centered approach helps you focus on the therapeutic process—from diagnostic evaluation and testing to treatment selection.[books.google.ro]

Prognosis

  • 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]
  • 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]
  • Review article: portal vein obstruction – epidemiology pathogenesis, natural history, prognosis and treatment. Aliment Pharmacol Ther 2015; 41: 276-92. Manzano-Robleda Mdel C, Barranco-Fragoso B, Uribe M, Méndez-Sánchez N.[termedia.pl]
  • 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.[pennstatehershey.adam.com]

Etiology

  • 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]
  • IGBS is associated with both early and late onset sepsis and the most common etiologic agent of neonatal meningitis.[atlases.muni.cz]
  • 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]
  • 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. Garcia-Prats et al.[intechopen.com]

Epidemiology

  • 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]
  • 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]
  • Neonatal sepsis of nosocomial origin: An epidemiological study from the “Grupo de Hospitales Castrillo”. J Perinat Med., 30 (2002), pp. 149-157 [7.] K.K. Lai. Enterobacter sakazakii infections among neonates, infants, childrens and adults.[analesdepediatria.org]
  • 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]
Sex distribution
Age distribution

Pathophysiology

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

Prevention

  • 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 sepsis is probably the best management strategy as far as neonatal sepsis is concerned. Strategies include prevention of early-onset sepsis and prevention of late-onset sepsis.[elsevier.com]
  • 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]
  • 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 infections[medlineplus.gov]

References

Article

  1. Martius JA, Roos T, Gora B, et al. Risk factors associated with early-onset sepsis in premature infants. Eur J Obstet Gynecol Reprod Biol. 1999;85(2):151–158.
  2. Seaward PG, Hannah ME, Myhr TL, et al. International multicenter term PROM study: evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term. Premature Rupture of the Membranes. Am J Obstet Gynecol. 1998 Sep. 179(3 Pt 1):635-639.
  3. Romero R, Quintero R, Oyarzun E, et al. Intraamniotic infection and the onset of labor in preterm premature rupture of the membranes. Am J Obstet Gynecol. 1988 Sep;159(3):661-666.
  4. Khashu M, Osiovich H, Henry D. Persistent bacteremia and severe thrombocytopenia caused by coagulase-negative Staphylococcus in a neonatal intensive care unit. Pediatrics. 2006 Feb. 117(2):340-348.
  5. Engle WD, Rosenfeld CR. Neutropenia in high-risk neonates. J Pediatr. 1984;105(6):982–986.
  6. Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr. 1988;112(5):761–767.
  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.
  8. Vouloumanou EK, Plessa E, Karageorgopoulos DE, Mantadakis E, Falagas ME. Serum procalcitonin as a diagnostic marker for neonatal sepsis: a systematic review and meta-analysis. Intensive Care Med. 2011;37(5):747–762.
  9. Philip AG. Response of C-reactive protein in neonatal Group B streptococcal infection. Pediatr Infect Dis. 1985;4(2):145–148.
  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.

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Last updated: 2019-07-11 21:36