Symptoms

First of all, it is important to differentiate between systemic neonatal infection (neonatal sepsis) and topical neonatal infection, as both diseases have different causes and therapeutic consequences and consequences. There are two different forms of sepsis in newborns. One is called early onset sepsis or early onset infection if it occurs within the first 72 hours of the newborn’s life.

The most common cause is the germ Streptococcus agalactiae, closely followed by E. coli bacteria. Less frequently, listeria and staphylococci are the cause. The germs usually originate from the maternal vaginal flora and are usually transmitted to the child before birth in the course of an amniotic infection.

The pathogens enter the birth canal and uterus from the rectum and vagina of the mother and cause inflammation of the egg membranes there. The pathogens then enter the amniotic fluid surrounding the fetus. This mechanism causes the still unborn child to come into contact with the pathogens and aspirate them.

The result is then pneumonia in the baby. However, the pathogens can also be transmitted to the newborn during birth. Late sepsis or late-onset sepsis/infection is characterized by the onset of the disease 72 hours after birth.

This late sepsis can still occur in hospital or manifest itself when the parents have already taken the child home. The mechanism of onset is usually the same as in early onset sepsis. Here, too, it is pathogens that are transmitted from mother to child during birth and thus trigger the infection.

The immune system of the newborn is only able to contain the infection for a little longer, so that it appears a little later. The course of the infection can also deteriorate rapidly over a few hours. Nosocomial infections are strictly separated from these two forms of infection.

In these cases, germs are transmitted to the child during hospitalization, for example, through a lying vein access or intubation. Sometimes the nosocomial infection is also called late-onset sepsis. There are common risk factors that make the occurrence of sepsis in the newborn likely.

Both forms of sepsis are increased in preterm infants (before the 37th week of gestational age) and newborns with low birth weight. Late sepsis is also promoted by measures such as artificial feeding via a stomach tube or lying venous accesses. In early sepsis, the ammonium infection syndrome of the mother is a very high risk factor.

If group B streptococci are detected in the mother’s vaginal smear or if increased bacteria (bacteriuria) are found in the urine, the risk of early onset sepsis in the newborn is also greatly increased. Streptococci are gram-positive pathogens that can cause a wide variety of diseases. They play a major role in the development of newborn infections.

So-called group B streptococci are the most common pathogens causing neonatal sepsis. These are especially the pathogen Streptococcus agalactiae, which is usually transmitted to the child by the mother. This can happen during or before birth.

Particularly feared is the amniotic infection syndrome of the mother, which is especially caused by Streptococcus agalactiae (but also Staphylococcus, Enterococcus, etc.). This infection carries a high risk for a sometimes life-threatening sepsis of the baby but also of the mother and must be treated with antibiotics in any case. Signs of such an ammnion infection syndrome of the mother due to streptococci are high fever of the mother (>38°), a foul-smelling amniotic fluid, a pressure-painful uterus and premature contractions as well as a premature rupture of the bladder.

The examination findings show an increased CRP (C-reactive protein) and an increased BSG (blood sedimentation rate) in the mother as well as leukocytosis (increased white blood cell count). These three parameters represent classic inflammation values. In children, tachycardia (>100 heartbeats per minute) can be noticed even before birth.

The pathogens of a newborn infection can be transmitted to the child through the amniotic fluid even before birth. This usually occurs within the first three days of life and is therefore also known as early-onset sepsis.The most common pathogens include the group B streptococci (Streptococcus agalactiae), E. coli, listeria, klebsielles and Staphylococcus aureus. These bacteria usually enter the vagina via the rectum.

Via the vaginal flora, the bacteria then continue their ascent into the birth canal and into the uterus. This can also lead to an amniotic infection syndrome, in which the amniotic fluid and the unborn child are affected in addition to the egg membranes. As a result of the amniotic infection syndrome, a newborn infection can again develop.

A caesarean section prevents the newborn from becoming infected when passing through the vagina. However, a newborn infection cannot be completely prevented. In some cases an infection occurs before birth or just after birth.

In late neonatal infection (late-onset sepsis), the transmission of germs takes place either during birth and only breaks out later or after birth with germs during the stay in hospital (nosocomial). Accordingly, the signs of the disease appear later than in the case of early neonatal infection. The germ spectrum is also different.

Since a caesarean section is a surgical procedure, surgical complications can arise. Therefore, it should always be considered together with the specialist which type of birth is the safest for the individual. Umbilical infection (omphalitis) is a local infection in newborns. Typically, the pathogens, which are usually streptococci or staphylococci, are transmitted to the child by the mother, resulting in a bacterial inflammation of the navel. This infection is also promoted by changing diapers too rarely and a lack of hygiene.