Neonatal Sepsis: Causes, Symptoms & Treatment

There are a number of ailments that can pose a serious threat to a newborn baby’s life, and neonatal sepsis is one of them. Thorough knowledge of the disease can help fight the cause. Detecting the symptoms at the very onset aids in deciding the right treatment for this deadly disease. What is neonatal sepsis? Let us find out.

What is Neonatal Sepsis?

Neonatal sepsis is an invasive neonatal infection that can affect your baby. This bloodstream infection can cause fatal diseases like pneumonia, gastroenteritis, meningitis or pyelonephritis. Your baby’s immune system responds to the infection by attacking the baby’s own tissues and organs. Neonatal sepsis can affect a single body part or multiple parts. It is a very rare infection occurring only in 0.5 to 8.0 per 1000 births. However, the risk factors are more common in following cases such as:

• Babies who are born with low birth weight (LBW infants)
• Babies born with maternal prenatal risk factors (premature rupture of amniotic sac, lower strata of society, etc)
• Male babies
• Babies born with low Apgar score

Neonatal sepsis infection is usually a bacterial infection that affects the baby in the neonatal stage. Signs of this infection can be multiple and non-specific which include reduced infant activity, less intense sucking, increase in temperature, seizure, jaundice, diarrhoea, respiratory and abdominal complications along with other complications.

Early- & Late-Onset Neonatal Sepsis

Neonatal sepsis can occur as early as within three days after birth or later. As per the time and source of infection, we can broadly classify neonatal sepsis into two categories:

1. Early Onset Neonatal Sepsis (EOS)

This type of infection occurs within 72 hours after birth and it is generally caused by maternal intrapartum transmission of invasive organisms. Babies with very low birth weight are at a greater risk of catching this infection. Various lab tests determine the probable cause of this infection.

2. Late-Onset Neonatal Sepsis (LOS)

This kind of neonatal sepsis generally is seen in babies who are hospitalised for a longer duration at hospitals in intensive care units. Symptoms of this kind of infection become evident few days after the birth. This kind of infection is usually caused by the postnatal acquisition of the pathogens.

Both these infections may cause equally fatal complications in a newborn baby. Early detection of the type of sepsis aids is s correct and timely treatment of the disease.

Causes of Neonatal Sepsis

In most cases of neonatal sepsis, the major cause is a bacterial infection. Bacterial sepsis in a newborn is caused by E.coli. The newborn baby is more susceptible to this infection is because of low immunity. Following are various causes of neonatal sepsis:

• This infection can be passed on to the infant during pregnancy, labour or delivery. The bacteria from the mother’s body can enter the baby’s body anytime.
• Premature babies who are kept in ICU’s are also at a high risk of catching this infection because of various caretaking procedures which include IV pipes, catheters, etc. The bacteria can enter the baby’s body and cause serious infection.
• If the mother has a fever during labour, the baby is at risk of getting infected.
• Premature rupture of amniotic sac also can lead to this infection in infants.
• Any infection in placenta or uterus can also be passed on to the unborn child and lead to neonatal sepsis.

Signs and Symptoms

The signs and symptoms of neonatal sepsis are not only listless but also difficult to identify. This infection remains one of the leading cause of mortality and morbidity in full term and preterm babies. Therefore, it becomes very important to identify the symptoms of this deadly disease at the very onset to avoid further complications. Few symptoms are listed below:

• Unusual breathing: If you notice any unusual breathing pattern in your baby or you find your baby breathing heavily, you need to report it to your doctor.
• Problem in feeding: If the baby has difficulty in sucking or shows disinterest in feeding, it is advisable to seek help.
• Vomiting: Any unusual reason behind vomiting of your newborn child is a matter of concern and the baby’s doctor should be intimated.
• Fever: If your infant is having fever ranging from 100°F to higher, it must be brought to the notice of a doctor.
• Less urination: When the baby is not passing urine often or there is a change in the frequency.
• Change in the heart rate: The baby’s heart rate may become slower or faster than usual.
• Swelling around the fontanel: Any bulging, swelling or protrusion on the fontanel or the soft spot on the baby’s skull.
• Change in the skin colour: There can be a change in colour of your baby’s skin. It can become pale or bluish. There can also be the appearance of the rash, also known as sepsis rash in babies.
• Change in the crying pattern: If your baby is crying excessively or in an unusual way or sound.
• Any changes in the body: Any stiffness or floppiness in your baby’s body or muscles could be a sign of the infection.
• Change in behaviour/appearance: Any unusual change in behaviour or appearance can be a sign of concern and should be reported to your doctor at the earliest.

All the above signs and symptoms do not necessarily mean that your child has neonatal sepsis. But it is recommended and advised that medical help is sought as soon as you notice any of the above-mentioned symptoms in your baby. Neonatal sepsis survival rate depends on whether the signs and symptoms are registered at an early stage or not.

Diagnosis of Sepsis in Premature Babies

The trickiest task in the diagnosis of sepsis in premature babies is getting an accurate diagnosis. It is difficult because the symptoms are not only subtle but also can be confused with other ailments. Where adult symptoms can be easily identified, diagnosing sepsis in infants can be difficult because there are multiple conditions that resemble sepsis. One single test may not show accurate results, therefore a combination of tests help diagnose the ailment. Various lab tests prove to be effective is diagnosing sepsis. These lab tests include:

• X-ray: The x-ray is taken, usually of the infant’s chest to check for symptoms of pneumonia.
• Urine test: The baby’s urine is tested for any sign of bacterial infection in the body.
• CPR test: C-reactive protein test is done to establish the elevated levels of CPR.
• PCT test: The procalcitonin test also helps determine sepsis in infants and rather procalcitonin neonatal sepsis test is an effective tool for diagnosing the infection.
• Lumbar puncture: This test helps determine symptoms of meningitis in your baby. It is an infection of membranes covering the brain and the spinal cord. For this test, fluid from the spine is taken. This test is also called spinal tap.
• Haptoglobin test: This test determines the protein in the blood as increased levels of protein is indicative of infection.
• Testing of other fluids: The fluids from the baby in the IV or catheters, can also be tested for any bacteria.

Neonatal Baby Sepsis Treatment

As soon as your health practitioner establishes the symptoms or even suspects symptoms of neonatal sepsis in your baby, the treatment will start immediately. It is likely that you are advised to keep your baby in the hospital under the observation of experts. Antibiotics will be administered to the infant intravenously, through IV into the veins. Cardiopulmonary support and IV nutrition will be given to the infant till the illness stabilises. There will be a regular monitoring of:

• Fever
• Blood pressure
• Platelet count and other vital signs
• Blood and under rare circumstances, blood transfusion may also be required
• Temperature stability, because if your baby’s temperature is not stable then thermoregulatory support may be provided
• Infants who require longer IV antimicrobial therapy. In such cases, surgical consultation may be required

Apart from the above-mentioned treatments, there are other treatments such as exchange transfusion, granulocyte transfusion, IV immune globulin infusion etc. Though there are many treatments available, no clinical trials have proved that these treatments are beneficial.

Risk Factors

Risk factors associated with EOS or the early onset of sepsis includes complications that an infant may face in the mother’s uterus before the birth or soon after the birth. Following are the likely risk factors for EOS:

• Urinary tract infection in the mother
• Premature membrane rupture
• Premature birth
• Prolonged membrane rupture
• Chorioamnionitis – a bacterial infection caused by chorion membranes and foetal amnion
• Untreated maternal GBS colonization
• Preterm membrane rupture
• Less Apgar Score
• Poor prenatal care and nutrition
• Clinical history of recurrent abortion

The risk factors of LOS or late-onset of sepsis include the following:

• GI Tract pathology
• Continuous positive airway pressure or nasal cannula usage
• Premature birth
• Proton pump inhibitor (PPI) usage

All the above circumstances can prove to be fatal for the unborn or a newborn baby. It is recommended to seek medical help as soon as any risk factors associated with neonatal sepsis are registered.

How to Prevent Neonatal Sepsis?

Prevention is always better than cure and if as an expectant mother, you are well aware of the possible causes and symptoms of this deadly disease, your unborn or newborn baby can easily be prevented of neonatal sepsis. Various studies and researchers have also shown that early intervention and detection of neonatal sepsis can save lives. Following are a few measures that can be taken to prevent neonatal sepsis or you may call it neonatal sepsis care plan for your baby:

• Prenatal care: It is very important for the would-be mother to exercise great caution to prevent neonatal sepsis in her newborn child. Any infection or ailment in the mother during pregnancy such as fever, UTI, etc. before birth should be immediately reported to the doctor.
• Immunization: An infant can be immunized for some strains of pneumococcus and Haemophilus influenzae type-b that may cause sepsis, a kind of blood infection.
• Hand washing: It is very important to maintain proper hygiene and wash hands repeatedly before touching your newborn baby. Hygiene plays a vital role in warding off any infection.
• Abstain sick people to come in contact: Anyone with any kind of infection should not be allowed to come in contact with the baby as a newborn child’s immune system is not very strong and the child may become infected.
• Extra care for infants in nurseries or intensive care units: Infants who are put under supervision in the nurseries should be monitored properly. Various medical devices like IV, catheters, etc. can also cause infection.
• Precaution and education: Exercising great amount of caution and a thorough knowledge of pathophysiology of neonatal sepsis and etiology of neonatal sepsis can prevent neonatal sepsis in infants.

Like any disease or ailment in a newborn child is a matter of great concern and if neglected can lead to complications, neonatal sepsis poses a similar kind of threat. Though neonatal sepsis is a rare bacterial infection that affects a newborn baby it is very important for a mother to know everything about this deadly ailment to protect her newborn child from it. Prevalence of neonatal sepsis is 1 to 10 per 1000 births worldwide. The available data shows 10% of maternal and 26% of neonatal deaths take place.

This article talks about neonatal sepsis, it’s causes, symptoms and effects, and how to prevent it. The neonatal sepsis mortality rate has increased over the past two decades and thorough knowledge of this deadly disease and timely medical intervention can save lives.