INTRODUCTION

Sepsis in a newborn (sepsis neonatorum) is an infection that spreads throughout the

baby’s body. Sepsis occurs in less than 1 percent of newborns (1 out of every 100), but
accounts for up to 30 percent of deaths in the first few weeks of life. Infection is 5-10 times
more common in premature newborns and in babies weighing less than 5½ pounds than in
normal-weight, full-term newborns. Complications experienced during birth, such as premature
or prolonged rupture of the membranes or infection in the mother, put the newborn at increased
risk of infection. Sepsis is a term for severe infection that is present in the blood and spreads
throughout the body. In newborns, it is also called sepsis neonatorum or neonatal septicemia.

The symptoms onset of what is called early-onset neonatal sepsis is within six hours of
birth in over half the cases and within 72 hours in the great majority of cases. Sepsis that
begins four or more days after birth is called late-onest sepsis, and is probably an infection
acquired in the hospital nursery (a nosocomial infection). In both types of neonatal sepsis, the
infection may be only in the bloodstream, or may spread to the lungs (pneumonia), brain
(meningitis), bone (osteomyelitis), joints, or other organs in the body. Sepsis can develop
following infection by microorganisms including bacteria, viruses, fungi, and parasites.
Infection in babies can be contracted during pregnancy, from the mother's genital tract during
labor and delivery, or after birth from contact with others.

Sepsis in a newborn is more likely to develop when the mother has had pregnancy
complications that increase the likelihood of infection. Such complications may include the
following: premature rupture of the membranes (amniotic sac), or membrane rupture for an
extended length of time; bleeding problems; a difficult delivery; infection in the uterus or
placental tissues and fever in the mother.

The organism that is causing the infection may be identified by taking cultures of the
blood as well as from other sites of the body. Urine samples are often cultured for bacteria to
look for an infection in the urinary tract. Because only small samples of blood and other body
fluids are taken, sometimes no organism is found. However, the infant may still be treated if
other laboratory studies or the infant’s clinical appearance strongly suggest an infection.

Sepsis in a newborn is treated with antibiotics given intravenously. Antibiotics are often
started even before laboratory and culture results are available. The doctor may then switch to
a different antibiotic that is more specific to the baby’s infection once the results of laboratory
tests are back. The length of antibiotic treatment varies depending on the infant’s clinical
status, laboratory test results, and kind of infection. If blood cultures and other laboratory tests
are all negative, antibiotics may be stopped after 48 hours of treatment. If the infant’s cultures
are positive, or if the laboratory tests and clinical status are suggestive of infection, the infant
will be treated with antibiotics, usually anywhere from 7-14 days. When appropriately treated
with antibiotics and cared for in the intensive care unit, the great majority of newborns with
sepsis live without any long-term problems.
 Babies can also develop sepsis by contracting infections after birth from infected
persons or objects. Babies in the newborn intensive care unit (NICU) are at increased risk for
acquiring nosocomial (hospital-acquired) infections. Many babies in the NICU are premature
or have low birthweight which makes them more susceptible to infection and more likely to
need invasive treatments and procedures. Microorganisms that normally live on the skin may
cause infection if they enter the body through catheters and other tubes inserted into the baby's
body.

What microorganisms cause severe infections and sepsis in babies?

Prenatal During After Birth

Delivery
rubella (German Group B respiratory
measles) streptococcus syncytial virus
(GBS) (RSV)
cytomegalovirus E. coli Candida
(CMV)
varicella-zoster virus herpes simplex Haemophilus
(chickenpox virus) virus influenzae type b
(Hib)
Listeria . enterovirus
monocytogenes

Sepsis can be life threatening for newborns, especially if the baby has a weakened
immune system because of prematurity or another illness. When a baby's immature immune
system cannot fight the microorganism, the infection can quickly spread and overtake the body,
causing serious illnesses such as meningitis or pneumonia.

Sepsis in newborns is not always easy to identify since newborn babies often do not show
symptoms of infections in the same way older babies and children may show symptoms. The
following are some of the symptoms of infection in newborn babies. However, each baby may
experience symptoms differently depending upon the type of organism causing the infection
and the severity and location of the infection. Symptoms of infection may include the
following: apnea (stopping breathing) or difficulty breathing; bradycardia (decreased heart
rate); decreased temperature or temperature instability; weak suck; jaundice (yellow coloring
of the skin and eyes)

Early diagnosis and treatment of the infection are important in helping prevent sepsis from
overwhelming a baby's body. However, cultures of blood and body fluids may take several
days for the organism to grow and be identified. Because of this, babies who are at increased
risk for sepsis, such as premature or low birthweight babies, may have preventive antibiotic
treatment started as soon as cultures are taken. Most medications are given intravenously (IV).
 Sepsis can be life threatening as the infection can affect several body systems at the same
time. This can make providing treatment more difficult. Babies with sepsis will require care in
the newborn intensive care unit (NICU), and may need antibiotics, other medications, and
specialized treatment (such as a mechanical breathing machine). The healthcare team will be
working to provide the best care to treat the infection and care for your baby.