Neonatal Problems: Sepsis Neonatorum

Sepsis in a newborn (sepsis neonatorum) is a severe bacterial infection that spreads throughout the body in the first month of life. Sepsis occurs in fewer than 1 percent of newborns but accounts for up to 30 percent of deaths in the first few weeks of life. Bacterial infection is five times more common in newborns weighing less than 5½ pounds than in normal-weight full-term newborns. Sepsis affects twice as many boys as girls. Complications experienced during birth, such as premature rupture of the membranes or bleeding or infection in the mother, put the newborn at increased risk of sepsis.

Symptoms

Sepsis begins within 6 hours of birth in more than half the cases and within 72 hours in the great majority. Sepsis that begins 4 or more days after birth is probably an infection acquired in the hospital nursery (a nosocomial infection). A newborn with sepsis is usually listless, doesn't suck vigorously, and has a slow heart rate and a fluctuating body temperature (low or high). Other symptoms include difficulty in breathing, seizures, jitteriness, jaundice, vomiting, diarrhea, and a swollen abdomen. Symptoms depend on where the infection originated and where it has spread. For example, infection of the umbilical cord stump (omphalitis) may cause a discharge of pus or bleeding at the navel. Infection of the lining of the brain (meningitis) or a brain abscess may cause coma, seizures, rigid arching of the back, or bulging fontanelles (the two soft spots between the skull bones). Infection of a bone (osteomyelitis) may restrict movement in the affected arm or leg. Joint infection may cause swelling, warmth, redness, and tenderness over the joint. Infection of the inside lining of the abdomen (peritonitis) may cause a swollen abdomen and bloody diarrhea.

Diagnosis

The organism causing the infection is identified by taking blood samples and culturing any obviously infected part of the body. Antibody tests may help identify the organism. A urine sample is also examined under a microscope and cultured for bacteria. A spinal tap (lumbar puncture) is performed if the doctor suspects meningitis. Samples of fluid from the ears and from the stomach may be taken for examination under a microscope.

Prognosis and Treatment

Sepsis in a newborn is treated with antibiotics given intravenously. Treatment is started even before laboratory results are available; a different antibiotic may later be chosen based on the results of laboratory tests. In rare cases, the infant may also be given a preparation of purified antibodies or white blood cells. Despite modern antibiotics and intensive care, 25 percent or more of newborns with sepsis die. The death rate is twice as high in small, premature newborns as in normal-weight, full-term newborns.

From The Merck Manual of Medical Information – Home Edition , edited by Mark H. Beers and Robert Berkow. Copyright 1997 by Merck & Co., Inc., Whitehouse Station, NJ: http://www.merck.com/mmhe/index.html