Overview

• Neonatal Sepsis → serious bacterial or viral infection in the blood affecting babies within first 28 days of life.
  • Early-onset (EOS, within 72 hours of birth) or late-onset (LOS, between 7-28 days of life).
  • Most common causes are group B streptococcus (GBS - streptococcus agalactiae) and E.coli.
  • EOS (<72 hrs) is usually due to GBS infection (transfer from mother to neonate during delivery). May also be due to e.coli and listeria.
    • Women with a previous baby with early- or late-onset GBS disease → offer maternal IV antibiotic prophylaxis (benzylpenicillin).
  • LOS (>72 hrs) is usually due to transmission of pathogens from the environment post-delivery (staph epidermidis → coagulase-negative staph are most common). (staph aureus = coagulase positive).
  • Risk Factors → mother with GBS colonisation, premature baby (<37 weeks), low birth weight (<2.5kg), chorioamnionitis.

Making Diagnosis

Clinical Features

• Neonatal Sepsis ⇒

  • Respiratory Distress (MOST COMMON PRESENTATION OF NEONATAL SEPSIS) → grunting, nasal flaring, use of accessory muscles, tachypnoea.
  • Tachycardia.
  • Apnoea.
  • Jaundice.
  • Seizures.
  • Reduced feeding, abdominal distension, vomiting.

  <aside> 💡 Consider in infants with vague signs such as poor feeding, grunting and lethargy.

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Investigations

• Bloods → clotting (DIC), blood culture, VBG (glucose and lactate), FBC, U&Es, creatinine.
• Lumbar Puncture → if concern of meningitis as source.
• CXR and Urine Dip → assess source.
• LP → assess if meningitis is cause of sepsis.

Management Plan

• 1st Line → IV Benzylpenicillin + Gentamicin.
  • (Meningococcal Sepsis → IM benzylpenicillin in community. IV ceftriaxone in hospital.)
• PAEDIATRIC SEPSIS 6 → 3 in: oxygen, IV fluids, IV antibiotics. 3 out: lactate, blood cultures, urine output.
• Other Measures → oxygen, fluids + electrolytes, prevention of hypoglycaemia, prevention of metabolic acidosis.

Complications →