Out of the various kinds of issues that a newborn is susceptible to, Neonatal Sepsis is quite a serious one. This is a life-threatening infection that occurs when a baby is 28 days old. Neonatal sepsis is a medical emergency which requires immediate treatment with antibiotics.

Let’s understand this condition in more detail.

What is Neonatal Sepsis?

A serious medical condition, neonatal sepsis or sepsis affects infants less than 28 days old. It occurs when the child’s body has an extreme response to infection. A newborn suffering from sepsis can have inflammation throughout the body as well as blood clotting. Both of these reduce blood flow to the infant’s limbs and vital organs, which can eventually lead to organ failure and even death.

Neonatal sepsis is usually classified into two categories based on the age of onset:

• Early-onset neonatal sepsis: This term is used to describe sepsis that develops within the first 72 hours of a child’s life.
• Late-onset neonatal sepsis: This term is used to describe sepsis that develops after three days of an infant’s life.

Who is at Risk of Developing Neonatal Sepsis?

Although every infant is at risk of developing neonatal sepsis, premature babies are at an increased risk of developing it as their immune systems are less mature than full-term babies. Prematurely born babies do not have enough antibodies to protect them from bacteria as they are born before they can receive the antibodies from their mothers.

In general, neonatal sepsis is common in infants who:

• Are born with a low birth weight.
• Have a low Apgar score, a quick evaluation given to babies after they are born. The Apgar score is used by healthcare providers to determine whether the baby needs immediate medical attention.
• Are assigned male gender at birth.
• One of the birthing parents has certain risk factors such as infection during pregnancy.

Causes of Neonatal Sepsis

Let us now understand what causes this condition.

Neonatal sepsis is primarily a bacterial infection caused by bacteria such as Listeria, Escherichia coli (E coli) and certain strains of streptococcus. One of the major causes of neonatal sepsis was Group B streptococcus (GBS), although the issue became less common once women started to get screened for GBS during pregnancy. Another major cause of the disease is herpes simplex virus (HSV) in a newborn. This often happens when the mother is newly infected with HSV.

Early onset neonatal sepsis usually appears within 24 to 48 hours of birth as the baby gets the infection from the mother before and during delivery. The risk of early-onset bacterial sepsis is also increased due to:

• Premature delivery
• GBS colonisation during pregnancy
• Rupture of membranes or water breaking for more than 18 hours before birth
• Infections of the amniotic fluid or placenta issues

In the case of late-onset neonatal sepsis, infants are infected after the delivery. The risk of this subcategory increases when:

• There’s a catheter in a blood vessel for a long time
• The infant stays in the hospital for a long time.

Symptoms of Neonatal Sepsis

Many symptoms of neonatal sepsis are similar to the ones your baby might have when they have some other illness. And it’s important to remember that more often than not your child may not have sepsis at all. However, if your child has more than one of the following symptoms or they are sicker than normal, it can be a better idea to seek medical intervention right away.

The most common symptoms of neonatal sepsis are:

When Should You Take Your Child to the Emergency?

If you get home from the hospital with your newborn and notice that your child has developed any of the above symptoms, it is best to go to the nearest emergency room. Look out for the following symptoms:

• Your baby’s skin Is pale, cold or discoloured
• Your baby is abnormally irritated or sleepier than normal.
• Your baby hasn’t passed urine or stool for more than 12 hours.
• Your baby is facing issues with breathing or is unresponsive.

Diagnosis of Neonatal Sepsis

Healthcare providers have to follow specific guidelines to diagnose neonatal sepsis. They will start by asking you about your child’s medical history. You will often hear the words ‘sepsis work-up’ about neonatal sepsis. A sepsis work-up is the set of tests used to diagnose the cause of the baby’s infection. Components of the sepsis work-up include:

• Urine tests: Urine culture and urine analysis.
• Blood tests: Blood cultures, complete blood count and c-reactive protein.
• Imaging tests: Ultrasound and chest X-ray
• Spinal tap (lumbar puncture): A small needle is inserted in the space around the baby’s spine to withdraw spinal fluid to test for infections.

Treatment of Neonatal Sepsis

Let’s discuss some treatment options now. The first step that the healthcare provider might take is to admit your baby to an intensive care unit (ICU).

In general, the treatment for sepsis includes:

• Intravenous fluids
• IV antibiotics for fighting bacterial infections.
• Antiviral medication for fighting viral infections.
• Medications for the heart and managing blood pressure.
• Extra oxygen and different kinds of respiratory support, in case your baby requires them.
• Sometimes, babies may need blood transfusions too.

How Can You Prevent Your Child from Getting Neonatal Sepsis?

Your paediatrician may recommend preventive antibiotics as a precaution against neonatal sepsis. Pregnant women are given IV antibiotics for several hours before delivery if:

• They have infections such as chorioamnionitis.
• They have group B strep colonization in the vagina.
• They have had a previous baby born with sepsis.

As a mother, you can take steps to prevent sepsis including:

• Regularly meet your doctor or the healthcare team.
• Follow good hygiene practices.
• Be aware of the signs of sepsis.
• Get immediate medical attention if you feel your baby has sepsis.

Prognosis of Neonatal Sepsis

Let’s discuss the prognosis now. The good news is newborn sepsis is curable. In many cases, newborns who suffer from sepsis recover completely and do not have any issues later on. However, neonatal sepsis is a leading cause of infant death. The most important thing is to get your baby treated at the earliest. It is estimated that the risk of death increases by around 7.6% for every hour passed without treatment.

Complications of Neonatal Sepsis

Most infants recover from sepsis and do not develop any complications in the future. However, more than one-third of infants who survive from neonatal sepsis experience a delay in cognitive skills and almost half the children return to the hospital at least once after recovery.

One of the primary complications is meningitis, an infection of the membranes of the brain. Infants may develop more serious symptoms such as:

• Loss of hearing
• Lethargy and extreme sluggishness
• Fontanelle, a bulging of the soft spot between the skull bones
• Cerebral palsy
• Developmental delays
• Coma
• Seizures

Sources:

• https://my.clevelandclinic.org/health/diseases/sepsis-in-newborns
• https://medlineplus.gov/ency/article
• https://www.news-medical.net/health/Diagnosis-and-Treatment-of-Sepsis-in-Newborns
• https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/sepsis-in-neonates