Neonatal sepsis is a bacterial infection in newborn infants that occurs in 0.1 to 0.8 percent of all newborns. It occurs primarily when the immune system is not fully mature, as in premature infants. A distinction is made between early and late sepsis, depending on the time of infection.
What is neonatal sepsis?
If infection of the newborn occurs before or during birth, it is early sepsis. The leading pathogens transmitted from mother to newborn are beta-hemolytic streptococci and Escherichia coli. These enter the vagina through the rectum, inflame the membranes of the egg, and can thus easily enter the amniotic fluid. Alternatively, they are ingested by the baby immediately during the birth process. The bacteria spread into the blood and cause exuberant foci of infection that can lead to septic shock. In late sepsis, the first symptoms are not apparent until after the first week of life. In this case, infection with the pathogen occurred either vertically during the birth process or through direct contact with the germs. In particular, if invasive methods are used during birth, such as the use of forceps, the infant’s skin can be injured, thereby allowing the germs direct access. Unlike early sepsis, the immune system can suppress the infection for a time.
Causes
The cause of neonatal sepsis is an insufficiently mature immune system in the child. This is often the case if the child is born before reaching 37 weeks of gestation. There is a direct correlation between low birth weight and risk for neonatal sepsis. Maternal infection with beta-hemolytic streptococci or other pathogens is a prerequisite for early sepsis, which can occur in utero. The presence of amniotic infection syndrome, in which the amniotic sac and membranes are infected, also leads to neonatal sepsis. An increased risk of neonatal sepsis is posed by premature rupture of the membranes, which opens the way for all bacteria directly into the uterus.
Symptoms, complaints, and signs
Symptoms appear either on the first day of life or after the first week of life, depending on the form of sepsis. The transition from a healthy-seeming infant to a severely ill state is usually erratic, with septic shock, which can lead to death, beginning after only a few hours. Depending on the site of initial infection, the first changes may be noted there. These signs of infection can appear on the respiratory organs, on the skin or in the digestive system. Externally, the infection first makes itself visible in diffuse symptoms, such as a weakness in drinking, an increased temperature and a sensitivity of the child to touch. If the infection occurred in the respiratory system, respiratory distress syndrome may occur or cessation of breathing may be noted. Signs of infection on the skin manifest as edema, pustules, inflammation of the umbilical cord, or yellowing of the eyes. If the nervous system is affected, apathy, impaired consciousness, drowsiness, convulsions, or bulging fontanelles are warning signs of neonatal sepsis. In late-onset sepsis, infants are often affected by meningitis. Infection of the digestive tract is associated with refusal of food, diarrhea or constipation, and enlargement of the liver and spleen.
Diagnosis and course of the disease
To clarify the pathogens, the first diagnostic measure is a blood draw, from which a blood culture is obtained. If the findings show a lack of leukocytes – a leukopenia, this is usually considered a sure sign of sepsis. In the case of late sepsis, urine cultures are taken, and if meningitis is present, the bacteria causing the infection are determined by means of a lumbar puncture. With timely treatment by administration of antibiotics, neonatal sepsis can be rapidly cured. Sometimes pulmonary hypertension or damage to the nervous system remains. However, if the initial alarm signs are missed, the infection can cause septic shock in the newborn, resulting in death within a few hours.Delayed treatment is present in 10 to 25 percent of cases.
Complications
Neonatal sepsis, as a potentially life-threatening infection, can result in numerous complications. If there is a symmetrical, or very even, distribution of toxins or bacteria in the bloodstream, there is definitely a danger to life without immediate treatment. Affected babies must be urgently monitored in intensive care because they do not have a sufficiently developed immune system. Thus, degradation of toxic substances or successful control of bacteria is primarily the responsibility of a physician. After the usual initial symptoms, the newborn may develop non-specific complications that are difficult to assess. Over time, sepsis affects more and more organs. An increased heartbeat as well as respiratory distress usually occur rapidly. A deposit of microorganisms in the ear can lead to a severe middle ear infection with closure of the auditory canal. A particularly high risk potential is posed by possible meningitis (meningitis of the brain). A swollen fontanel and very high-pitched crying are characteristics of this complication. Similarly, pneumonia can develop as a consequence of sepsis. Typically, babies consume very little fluid during sepsis and are at risk of dehydration as a result. Long-term damage or death of the offspring due to septic shock with multiple organ failure if therapy is started too late cannot be ruled out. Permanent neurological dysfunction and high blood pressure in the pulmonary vessels occur depending on the severity of the course. If the disease is detected in time, the risk of intolerance due to antibiotic treatment remains. The mortality rate in these conditions is approximately four percent.
When should you see a doctor?
If the birth of a child takes place in an inpatient setting or a birth center, the mother and child are generally accompanied by obstetricians during the delivery. In most cases, the accompaniment continues for a few hours or days after the birth. If irregularities of the newborn’s health condition appear during this time, the nurses, midwives or doctors take over the infant’s examinations. If any abnormalities or peculiarities of the health condition are noticed by them, medical care of the newborn is automatically provided. In these cases, the parents or relatives do not need to take action. If newborn sepsis develops after discharge from the hospital or cooperation with obstetricians, a visit to the doctor is necessary. Refusal of food, fever or behavioral abnormalities should be assessed and clarified by a physician. If an apathetic demeanor or listlessness occurs, there is cause for concern. Increased need for sleep, rapid fatigue, and lack of response to social interactions should be discussed with a physician. Changes in skin appearance, convulsions, or respiratory dysfunction need to be evaluated by a physician. Because neonatal sepsis can lead to premature death without medical treatment, a visit to a physician is advised at the first signs of irregularity.
Treatment and therapy
Treatment of neonatal sepsis is by antibiotics administered by infusion. Broad-spectrum antibiotics are resorted to initially and are used while blood and urine culture results are pending. In the case of early sepsis, aminopenicillin or a combination of cephalosphorin / aminopenicellin is administered. In addition to treatment of the infection, complementary measures are taken to stabilize the condition of the newborn. In addition to fluid administration via an infusion, ventilation may be necessary. Possible hypoglycemia or anemia are also treated.
Outlook and prognosis
In principle, neonatal sepsis always requires intensive medical care. Because it is a highly acute clinical picture, it represents an emergency. Therefore, the prognosis depends on how quickly therapy is initiated. Consequential damage can only be avoided if treatment is initiated as quickly as possible. The prognosis depends on the duration of the neonatal infection. The longer it has been present, the more organs are affected and the higher the risk of spreading to the brain.At worst, neonatal sepsis can cause septic shock, which ends in circulatory failure. This would result in kidney and lung failure, and in the worst case, multi-organ failure. Without therapy, neonatal sepsis can therefore be fatal within a few hours to days. It is crucial for the prognosis that therapy is initiated as early as possible. Good prophylaxis and rapid antibiotic treatment contribute to the fact that only about four percent of children die from neonatal sepsis. Therapy should begin at the time of mere suspicion; antibiotics can then still be adjusted if the pathogen is detected. Provided that the newborn recovers from the disease, long-term consequences are usually not to be expected. However, if meningitis occurs in the course of neonatal sepsis, delayed development, cerebral palsy, or hearing loss may be seen as a consequence.
Prevention
In many countries, a swab is taken from the mother’s vagina and rectum between the 35th and 37th week of pregnancy. This is examined for group B beta-hemolytic streptococci, which are primarily responsible for early sepsis. If positive, the mother is given an infusion of antibiotics, such as penicillin G or ampicillin, immediately before natural delivery. This measure significantly reduces the risk of infection. To avoid late sepsis, elementary hygiene measures, such as hand washing, are essential when dealing with children.
Follow-up
In most cases of neonatal sepsis, only very limited measures of direct aftercare are available to the patient. In this context, death of the child may also occur in the worst case if neonatal sepsis is recognized and treated late. Therefore, especially the parents should pay special attention to the symptoms and complaints of this disease and also immediately consult a doctor and initiate treatment, so that no further complications and complaints can occur. Newborn sepsis is usually alleviated and completely limited by taking various medications and antibiotics. The correct dosage and regular intake should be observed in order to prevent further complications and complaints. If there is any uncertainty or if there are any questions, a doctor should be consulted first. In many cases, parents are dependent on the help and support of their own family in the case of neonatal sepsis. This can also prevent and alleviate psychological upsets or depression in particular. If neonatal sepsis is detected and treated early, there is usually no reduction in the life expectancy of the affected person.
Here’s what you can do yourself
Self-help measures are not indicated for neonatal sepsis. There are no options that will relieve the symptoms without medical care. Because the child’s life is in danger, intensive medical care is necessary. By their very nature, newborns cannot bring about changes in their situation. Parents and relatives also find themselves helpless in the face of developments in the infant’s acute health condition. The actions of physicians should be trusted at this time. Parents should seek comprehensive information about the infant’s condition and ask any unanswered questions to the care team. In addition, specialist literature on the disease can be consulted to find out what developments can be expected and what room for maneuver is available. Internal disagreements and disputes should be avoided at all costs in this situation. When it comes to decision-making, it should be possible to act as quickly as possible in the best interests of the newborn, and this succeeds if all those concerned work together in harmony. Time delays or the need to involve the authorities can have a devastating effect on the child’s health, as treatment measures often have to be initiated quickly and the parents’ consent is required for this. For mental strengthening, relatives should be supportive of each other or seek professional help.
