Neonatal Sepsis

What neonatal sepsis is

Newborns have immature immune systems, so infections can spread quickly from a single site, such as the lungs, urine or umbilical cord, into the blood. The body's response to infection can then cause low blood pressure, poor circulation and organ damage. Sepsis can progress within hours, which is why early recognition matters.

Types

Risk factors

For early-onset sepsis

• mother carrying group B strep without antibiotics in labor
• fever or infection of the membranes during labor (chorioamnionitis)
• waters broken 18 hours or more before delivery
• premature birth before 37 weeks
• a previous baby with GBS disease

For late-onset sepsis

• prematurity and low birth weight
• long hospital stays, central lines and breathing machines
• surgery
• urinary tract abnormalities

Signs and symptoms

Signs in newborns are often nonspecific:

• poor feeding, sucking weakly or not waking for feeds
• lethargy, floppiness or unusual irritability
• temperature instability: fever, or a low temperature, which is common in premature babies
• fast breathing, grunting, flaring nostrils, pauses in breathing (apnea)
• pale, gray or mottled skin; slow return of color after pressing the skin
• fast or slow heart rate
• vomiting, swollen belly or diarrhea
• jaundice
• seizures, a bulging fontanelle or high-pitched cry, which can indicate meningitis
• low blood sugar

Trust your instincts: if your baby seems "not right," seek care.

Diagnosis

• Blood culture: the key test to identify bacteria; results take 24 to 48 hours.
• Complete blood count and CRP: markers of infection.
• Lumbar puncture: spinal fluid testing for meningitis.
• Urine culture: especially in late-onset sepsis.
• Chest x-ray if breathing is affected.
• Blood gas, glucose and other tests to assess severity.

For well-appearing newborns with risk factors, many hospitals use the neonatal early-onset sepsis risk calculator to decide whether to test, observe or treat.

Treatment

• Intravenous antibiotics started immediately after cultures are taken, usually a combination covering group B strep, E. coli and Listeria, adjusted once results are known. Treatment usually lasts 7 to 10 days for blood infection, longer for meningitis.
• If cultures are negative at 36 to 48 hours and the baby is well, antibiotics are usually stopped.
• Supportive care: fluids, breathing support, oxygen, medicines to support blood pressure, treatment of low blood sugar and jaundice, feeding support.
• Antifungal medicines for fungal sepsis in premature babies.

Complications

• septic shock and organ failure
• meningitis, which can cause hearing loss, developmental delay and cerebral palsy
• breathing failure
• death, especially in very premature babies

Prevention

• GBS screening with a swab at 36 to 37 weeks of pregnancy, and intravenous antibiotics during labor for carriers. This has reduced early-onset GBS disease substantially.
• Antibiotics in labor when the mother has a fever or other risk factors.
• Hand washing by everyone handling the baby.
• Clean cord care: keep the stump clean and dry.
• Breastfeeding, which provides protective antibodies.
• Hospital infection-control practices for NICU babies.
• Keep newborns away from people who are sick.

Outlook

Most babies treated promptly recover fully. Outcomes are worse for very premature babies, those with meningitis or septic shock, and when treatment is delayed. Babies who had meningitis need hearing tests and developmental follow-up.

Frequently asked questions

What are the signs of sepsis in a newborn?

Signs include poor feeding, unusual sleepiness or floppiness, a high or low temperature, fast or labored breathing, pale or blotchy skin, vomiting, jaundice and irritability. Signs are often subtle. Any baby under 3 months with a temperature of 38 °C (100.4 °F) or higher needs emergency care.

What causes neonatal sepsis?

The most common causes are group B streptococcus and E. coli, often picked up from the mother around birth. Later infections can come from the environment or hospital equipment, including staph bacteria. Premature babies are at highest risk.

How is neonatal sepsis treated?

Babies receive intravenous antibiotics in hospital, started as soon as blood and other samples are taken. They also get support for breathing, blood pressure, feeding and blood sugar as needed. Treatment usually lasts 7 to 10 days, longer with meningitis.

Can neonatal sepsis be prevented?

Many cases can. Group B strep testing in pregnancy and antibiotics during labor for carriers greatly reduce early-onset sepsis. Hand washing, breastfeeding, clean cord care and avoiding sick contacts also help prevent infections.

What is the difference between early-onset and late-onset sepsis?

Early-onset sepsis starts in the first 72 hours and usually comes from the mother during delivery, most often group B strep or E. coli. Late-onset sepsis starts later and is often linked to the environment or hospital care, especially in premature babies.