Neonatal sepsis is a bacterial infection in newborns that occurs in 0.1 to 0.8 percent of all newborns. This occurs above all when the immune system is not yet fully mature, as in the case of premature babies. Depending on the time of infection, a distinction is made between early and late sepsis.
What is neonatal sepsis?
If the newborn is infected before or during birth, it is called early sepsis. The leading pathogens transmitted from mother to newborn are beta-hemolytic streptococci and Escherichia coli. These enter the vagina via the rectum, inflame the fetal membranes and can thus easily get into the amniotic fluid. See percomputer for Cerebral Edema Explanation.
Alternatively, they are picked up by the child immediately during the birth process. The bacteria spread in the blood and cause excessive infection foci that can lead to septic shock. In the case of late sepsis, the first symptoms can only be recognized after the first week of life. The infection with the pathogen took place 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 baby’s skin can be injured and thus give the germs direct access. In contrast to early sepsis, the immune system can suppress the infection for a while.
The cause of neonatal sepsis is an underdeveloped immune system in the child. This is often the case when the child is born before the 37th week of pregnancy is reached. There is a direct correlation between low birth weight and the risk of neonatal sepsis. An infection of the mother with beta-hemolytic streptococci or other pathogens is a prerequisite for early sepsis, which can already occur in the womb.
The presence of amniotic infection syndrome, in which the amniotic sac and membranes are infected, also leads to neonatal sepsis. There is an increased risk of blood poisoning in the newborn if there is a premature rupture of membranes, which clears the path for all bacteria directly into the uterus.
Symptoms, Ailments & Signs
Depending on the form of sepsis, the symptoms appear either on the first day of life or after the first week of life. The transition from a seemingly healthy child to a seriously ill condition is usually erratic, with septic shock, which can lead to death, setting in after just a few hours. Depending on where the initial infection occurred, the first changes can be detected there.
These signs of infection can appear on the respiratory organs, on the skin or in the area of the digestive system. Externally, the infection first manifests itself in diffuse symptoms, such as poor drinking, an elevated temperature and the child’s sensitivity to touch. If the infection occurred in the respiratory system, respiratory distress syndrome may occur or breathing pauses may be noted.
The signs of infection on the skin are expressed in edema, pus blisters, inflammation of the umbilical cord or yellowing of the eyes. When the nervous system is affected, apathy, impaired consciousness, drowsiness, convulsions, or bulging fontanelles are warning signs of neonatal sepsis.
In the case of late sepsis, children are often affected by meningitis . Infection of the digestive tract is associated with refusal to eat, diarrhea or constipation and an enlarged liver and spleen.
Diagnosis & course of disease
To clarify the pathogens, the first diagnostic measure is a blood sample, from which a blood culture is created. If the finding indicates a lack of leukocytes – leukopenia, this is usually considered a sure sign of sepsis. In the case of late sepsis, urine cultures are created and, if meningitis is present, the bacteria causing the infection are determined by means of a lumbar puncture.
With timely treatment through the administration of antibiotics, neonatal sepsis can be cured quickly. Sometimes pulmonary hypertension or damage to the nervous system remains. However, if the early warning signs are missed, the infection can send the newborn into septic shock, which can lead to death within hours. Delayed treatment occurs in 10 to 25 percent of cases.
As a potentially life-threatening infection, neonatal sepsis can have numerous complications. If there is a symmetrical, i.e. very even distribution of toxins or bacteria in the bloodstream, there is definitely a risk of death without immediate treatment. Affected babies urgently need to be monitored in the intensive care unit because they do not have a sufficiently developed immune system.
A breakdown of toxic substances or the successful fight against bacteria is therefore primarily the responsibility of medical care. After the usual initial symptoms, the newborn can develop unspecific complications that are difficult to assess. Over time, blood poisoning affects more and more organs. An increased heartbeat and shortness of breath usually occur quickly. Deposits of the microorganisms in the ear can result in a severe middle ear infection with blockage of the auditory canal.
Meningitis (inflammation of the meninges) poses a particularly high risk potential. A swollen fontanelle and very high-pitched crying are features of this complication. Pneumonia can also develop as a consequence of sepsis. Babies typically drink very little liquid during sepsis and are at risk of dehydration as a result. Long-term damage or the death of the offspring due to septic shock with multi-organ failure if therapy is started too late cannot be ruled out.
Permanent neurological malfunctions and high blood pressure in the pulmonary vessels occur depending on the severity and severity of the course. If the disease is recognized in good time, there is still a risk that intolerances may arise due to antibiotic treatments. The mortality rate under these conditions is about four percent.
When should you go to the doctor?
If the birth of a child takes place in an inpatient environment or a birthing center, mother and child are always accompanied by midwives during delivery. In most cases, the accompaniment continues for a few hours or days after the birth.
If irregularities in the health of the newborn appear during this time, the nurses, midwives or doctors take over the examinations of the infant. If they notice any abnormalities or peculiarities of the state of health, the newborn will automatically receive medical care. In these cases, the parents or relatives do not have to take any action.
If neonatal sepsis develops after discharge from the hospital or after working with the obstetrician, a doctor’s visit is necessary. A refusal to eat, fever or behavioral problems must be examined and clarified by a doctor. If there is an apathetic demeanor or apathy, there is cause for concern.
An increased need for sleep, tiring easily, and a lack of response to social interactions should be discussed with a doctor. Changes in the complexion, cramps or a disturbance in breathing must be examined by a doctor. Since neonatal sepsis can lead to premature death without medical treatment, it is advisable to consult a doctor as soon as the first irregularities appear.
Treatment & Therapy
Neonatal sepsis is treated with antibiotics administered via an infusion. Initially, broad-spectrum antibiotics are used while the results of blood and urine cultures are still pending. Aminopenicillin or a combination of cephalophorine and aminopenicellin is given for early sepsis.
In addition to treating the infection, additional measures are taken to stabilize the condition of the newborn. In addition to liquid administration via an infusion, ventilation may be necessary. Possible hypoglycaemia or anemia are also treated.
Outlook & Forecast
In principle, neonatal sepsis must always be treated in intensive care. Since it is a highly acute clinical picture, it represents an emergency. The prognosis therefore depends on how quickly the therapy is initiated. Consequential damage can only be avoided with the fastest possible treatment.
The prognosis depends on the duration of the neonatal infection. The longer this has existed, the more organs are attacked and the higher the risk of spreading to the brain. In the worst case, neonatal sepsis can trigger septic shock, which ends in circulatory failure. The result would be kidney and lung failure, in the worst case multi-organ failure. Without treatment, neonatal sepsis can be fatal within a few hours to days.
It is crucial for the prognosis that the 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 when there is a mere suspicion, and the antibiotics can then be adjusted if the pathogen is detected.
If the newborn recovers from the disease, there are usually no long-term consequences to be expected. However, if meningitis occurs as part of neonatal sepsis, delayed development, cerebral palsy or even hearing loss can result.
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 the test is positive, the mother is given an infusion of antibiotics, such as penicillin G or ampicillin, immediately before the natural birth. This measure significantly reduces the risk of infection. In order to avoid late sepsis, elementary hygiene measures such as washing hands are essential when dealing with children.
In the case of neonatal sepsis, in most cases the patient has only very limited direct follow-up measures available. In the worst case, the child may die if neonatal sepsis is not recognized and treated until late. Parents in particular should therefore pay particular attention to the symptoms and complaints of this disease and immediately consult a doctor and initiate treatment so that no further complications and complaints can occur.
The neonatal sepsis is usually alleviated and completely curbed by taking various medications and antibiotics. Care should be taken to ensure the correct dosage and regular intake in order to prevent further complications and symptoms. If anything is unclear or if you have any questions, you should first consult a doctor.
In many cases, parents with neonatal sepsis are dependent on the help and support of their own family. Above all, this can also prevent and alleviate psychological upsets or depression. If neonatal sepsis is recognized and treated early, the life expectancy of the affected person is usually not reduced.
You can do that yourself
Self-help measures are not indicated in neonatal sepsis. There is no way to alleviate the symptoms without medical care. Since the child’s life is in danger, intensive medical care is necessary. Naturally, newborns cannot bring about changes in their situation. Parents and relatives are also helpless in the face of the developments in the acute health condition of the infant.
The actions of the doctors can be trusted during this time. Parents should be fully informed about the condition of the offspring and ask any open questions to the care team. In addition, specialist literature on the disease can be used to find out what developments are to be expected and what scope for action there is. Internal discrepancies and disputes must be avoided at all costs in this situation.
When it comes to making decisions, it should be possible to act as quickly as possible in the interests of the newborn, and this will be successful if everyone involved works in harmony with one another. Time delays or the need for the authorities to get involved can have a devastating effect on the child’s health, since treatment measures often have to be initiated quickly and parental consent is required for this. For mental strengthening, relatives should support each other or seek professional help.