What is sepsis in newborns?

Neonatal Sepsis is has been defined as invasive bacterial infection in the first 90 days of life.

Signs are multiple: decreased spontaneous activity & suckling, apnea, bradycardia, temperature instability (hypo or hyperthermic), respiratory distress, vomiting, diarrhea, abdominal distention, jitteriness, seizures and jaundice.

Diagnosis is clinical with extensive laboratory testing.

Treatment is initially empirical with ampicillin plus gentamicin or cefotaxime, or directed at the most likely organism of the presentation until the organism can be pinpointed.

There are several ways of looking at neonatal sepsis:

Early vs late
Early sepsis is in the first 7 days of life with the majority of cases presenting in the first 6 hours to 72 hours.
Late sepsis is onset after 7 days and often acquired from the environment after birth.

Prepartum vs intrapartum vs postpartum
Prepartum is before birth infection. The fetus is infected prior to birth.
Intrapartum is during birth infection. The child is infected during birth.
Postpartum is after birth infection. The child is infected after birth.

Group B Streptococus (GBS) and Gram negative enteric bacteria (E.coli predominately) account for 70% of early onset sepsis. Vaginal or rectal cultures show 30% of maternal infection, 35% of their infants are then infected.

H. influenza neonate infection is increasing, mostly in premature infants.

Most other cases are enteric Kebsiella, gram positive- Listeria Monocytogene, enterococci (e.g.E. fecalis), group D streptococci (eg Strep bovis), alpha hemolyte strep and staphlococci.

Staphlococci account for 30 to 50% of late-onset sepsis, usually from contaminated Umbilical cathethers.

Enterbacter cloacae or E. sakazakii suggest contaminated feedings.

Contaminated respiratory equipment is linked to Pseudomonas aeruginosa.

Anaerobes, Bacteroi-desfragiis, is linked to deaths but mode of infection remains unclear.

Candida is increasingly important in late onset sepsis in 12% of low birth weight (LBW) infants.

Viral infections may appear in early or late onset sepsis (herpes simplex, enerovirus, adenovirus, and RSV).

Signs and symptoms may give a clue to the origin and organism with specific signs.

Early onset GBS and L. monocytogenes present with respiratory distress difficult to distinguish from hyaline membrane disease.

Periumbilica redness, discharge, or bleeding may suggest omphalitis (umbilical infection).

Coma, seizures, opisthotonos (body muscle spasm) or bulging fontanelle suggests meningitis or brain abcess.

Decreased spontaneous movement, swelling, warmth, redness, or tenderness over a joint indicate osteomyelitis or pyogenic arthritis.

Abdominal distention indicates peritonitis or necrotizing enterocolitis.

Cutaneous vesicles, mouth ulcers and hepatosplenomegaly with DIC indicate disseminated herpes simplex.

Early onset GBS may manifest as pnuemonia.

The Society of Critical Care medicine suggests a more manageable systemic response classification to newborn called SIRS.

SIRS is Systemic Inflammatory Response Syndrome identified clinically by two or more:
1. fever or hypothermia
2. tachycardia
3. hyperventilation
4. abnormal WBC or increase of immature forms

SIRS identifies criterion for initiating therapy which may be caused by immunological, endocrine, trauma, surgery, chemotherapy or infection without arriving at the exact cause or distinction between them, which includes sepsis.

Neonatal Sepsis may be caused by many different agents, and be approached from different ways.

http://kidshealth.org/parent/pregnancy_n...

Newborns have very little natural immunity, so any infection they get can soon spread throughout their body. Sepsis or septicemia is blood poisoning. Bacteria are present in the blood and they multiply and produce disease. More than one organ system is affected at the same time. Newborns with infection in the first week usually have pneumonia and with infection later, meningitis. Newborns are more susceptible to gram negative infections. A newborn with suspected infection should have culture and sensitivity tested from different sites and be given good broad spectrum antibiotcs. I hope this answers your question.