Neonatal sepsis

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Neonatal problems in general are related to maternal health, diabetes, hypertension, maternal medication use and substance abuse, and many other factors. The viability of the newborn is then related to its ability to adapt to extrauterine life after labour and delivery, intrauterine development, congenital anomalies, chromosomal defects, and maturity at birth.

Neonatal sepsis is the most serious life-threatening problem in the newborn. It is relatively common, with an incidence of between 1 and 10 in 1000 births, and up to 1 in 250 preterm births. The common infecting agents are Group B Streptococcus organisms, which can be acquired from the mother, or nosocomially.

Risk factors for neonatal sepsis include a prolonged rupture of membranes (usually 18-24 hours, but it can be less), chorioamnionitis, maternal fever, or maternal infections (e.g., UTI), invasive procedures (IVs, central lines), respiratory disorders, or prematurity.

Investigations

When a newborn is suspected of neonatal sepsis, he or she undergoes a Septic work-up, which includes a CBC and Differential, platelet count, blood culture, chest X-ray, lumbar puncture, gastric aspirate and surface swabs if <24 hours old. One general rule of investigating neonatal sepsis is that the team involved must never wait and see.

Management

The first step in the management of neonatal sepsis is a broad spectrum antibiotic. Currently, ampicillin and gentamicin are favoured. If sepsis is proven, the course of treatment is 7-10 days. If there is a strong suspicion (i.e., clinical picture), but cultures come back negative, treatment lasts for 7 days. If there are only transient symptoms, but negative cultures, the course is 48 hours. If meningitis is diagnosed, it is treated accordingly, usually for 2-3 weeks.

Resources