Neonatal Sepsis
Sepsis is bacterial infection in the blood.
Newborns, especially premature ones, are at much higher risk of sepsis than are children and adults because of their immature immune system. Premature newborns also lack certain antibodies against specific bacteria; these antibodies usually cross the placenta from the mother late in pregnancy. Another important risk factor for sepsis is the use of intravenous lines and ventilators.
The most common type of bacteria causing sepsis in the newborn around the time of birth is Group B streptococcus. Sepsis that occurs later while the newborn is being cared for in the neonatal intensive care unit (NICU) is most likely to be caused by a type of staphylococcus (coagulase negative).
 See the table Some Infections in Newborns.
Symptoms and Diagnosis
A newborn with sepsis is usually listless, does not feed well, and often has a low body temperature. Other symptoms may include pauses in breathing (apnea), fever, pale color, and poor skin circulation, with cool extremities, abdominal swelling, and jaundice.
Because newborns have decreased immunity against infection, bacteria in the bloodstream may invade and infect various organs. One of the most serious complications of sepsis is infection of the membranes surrounding the brain (meningitis). A newborn with meningitis may have extreme lethargy, coma, seizures, or bulging of the fontanelle (the soft spot between the skull bones). A doctor can rule out or diagnose meningitis by performing a spinal tap (lumbar puncture), examining the cerebrospinal fluid, and culturing a sample of this fluid. Infection of a bone (osteomyelitis) may cause pain and swelling of an arm or leg, often suspected because the newborn does not move that extremity. Infection of a joint may cause swelling, warmth, redness, and tenderness over the joint, again with little or no movement of that joint. If joint infection is suspected, a sample of fluid from the infected site is removed by needle and cultured.
Treatment and Prognosis
While awaiting blood culture results, a doctor gives intravenous antibiotics to a newborn with suspected sepsis. Once the specific organism has been identified, the type of antibiotic can be adjusted. In addition to antibiotic therapy, other treatments may be needed, such as use of a ventilator, intravenous fluids, and support of the blood pressure and circulation.
Sepsis is the major cause of mortality in premature newborns after the first week. Newborns who recover from sepsis should not have long-term problems, except those with meningitis, who may have mental delay, cerebral palsy, seizures, or hearing loss later in life.
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