Neonatal sepsis occurs when bacteria enter the bloodstream of infants less than 90 days old. It can cause overwhelming infection or spread to organs like the lungs (pneumonia) or meningitis. Common causes are E. coli, listeria, and certain streptococcus bacteria. Risk factors include preterm birth, maternal infection, and hospitalization after birth. Symptoms are non-specific but include temperature changes, breathing issues, poor feeding, and lethargy. Diagnosis involves blood, urine, and CSF tests and treatment is with antibiotics like ampicillin and gentamicin alongside supportive care. Outcomes can vary from full recovery to neurological or respiratory problems, especially in preterm infants.

1. Neonatal Sepsis
1R Dhaker, Lecturer, PCNMS

2. Introduction
• Neonatal Sepsis or sepsis neonatrum occurs
when pathogenic bacteria gain access into the
blood stream.
• They may cause overwhelming infection or
localize into lungs causing pneumonia or into
meaning causing meningitis.
• Neonatal Septicemia occurs in infants less than
90 days of age.
R Dhaker, Lecturer, PCNMS 2

3. Etiology
• A number of different bacteria including E. coli,
listeria and certain strains of streptococcus may
cause neonatal sepsis.
• Early onset neonatal sepsis most often appears
within 24 hours of birth.
R Dhaker, Lecturer, PCNMS 3

4. Cont… Etiology
• The following increase an infant’s risk of early
onset sepsis:-
– Group B streptococcus infection during pregnancy
– Preterm delivery and LBW baby
– Infection of placental tissue and amniotic fluid
– Multiple pervaginal examination
– Maternal fever and infection
• Babies with late neonatal sepsis get infected after
delivery by the organism thriving in the external
environment of the home or hospital.
R Dhaker, Lecturer, PCNMS 4

5. • The following increase infant’s risk of
developing late onset septicemia.
– Having an intracath in blood vessel for long time.
– Hospital stay for long time.
– Lack of aseptic technique following by care givers.
– Lack of breast feeding.
– LBW
– Superficial infection ( pyoderma, umbilical sepsis)
R Dhaker, Lecturer, PCNMS 5
Cont… Etiology

6. • Organisms that have been implicated in causing late-
onset sepsis include the following:
– Coagulase-negative Staphylococcus
– Staphylococcus aureus
– E coli
– Klebsiella
– Pseudomonas
– Enterobacter
– Candida
– GBS
– Serratia
– Acinetobacter
– Anaerobes
R Dhaker, Lecturer, PCNMS 6

7. Risk factors
• generally well-appearing
• previously healthy
– full term (at ≥37 weeks gestation)
– no antibiotics perinatally
– no unexplained hyperbilirubinemia that required treatment
– no antibiotics since discharge
– no hospitalizations
– no chronic illness
– discharged at the same time or before the mother
• no evidence of skin, soft tissue, bone, joint, or ear
infection
R Dhaker, Lecturer, PCNMS 7

8. Clinical Feature
• The manifestation of neonatal septicemia are
subtel, vague and non- specific.
• The most common compliant concerning infant’s
progress is “ failure to do well” or “ not looking
right”.
• Hypothermia is a common manifestation.
R Dhaker, Lecturer, PCNMS 8

9. The signs of sepsis are
non-specific and
include:
• Body temperature
changes
• Breathing problems
• Diarrhea
• Low blood sugar
• Reduced movements
• Reduced sucking
R Dhaker, Lecturer, PCNMS 9
• Seizures
• Bradycardia
• Swollen belly area
• Vomiting
• Yellow skin and whites
of the eyes (jaundice)

10. Cont… Clinical Feature
• Circulator system
– Pallor, cyanosis
– Cold, clammy skin
– Hypotension and
shock
– Edema
– Bradycardia or
tachycardia
R Dhaker, Lecturer, PCNMS 10
• Respiratory system
 Irregular
respiration , apnea,
 Cyanosis
 Grunting
 Dyspnea
 Retraction

11. Cont… Clinical Feature
• Central Nervous
System –
– Reduced activity
( lethargy , coma, poor
cry)
– Irritability , tremors
– Full fontanel
– Abnormal eye
movement
R Dhaker, Lecturer, PCNMS 11
• GI system-
• Poor feeding
• Vomiting
• Diarrhea or decreased
stool pass
• Abdominal distension
• Hepatomegaly

12. Cont… Clinical Feature
• Hematopoietic
system-
– Jaundice
– Pallor
– Ecchymosis
– Spleenomegaly
– Bleeding
R Dhaker, Lecturer, PCNMS 12
• Feature suggestive of
pneumonia include-
• Tachycardia
• Chest retractions
• Early cyanosis
• Poor feeding
• Lethargy

13. Diagnostic Evaluation
• Blood Culture
• Urine examination
• CSF study
• CBC
• C- reactive protein
• ESR may be elevated ( >15 mm 1st hour)
R Dhaker, Lecturer, PCNMS 13

14. Management
• For babies with neonatal sepsis,
–Supportive care and
–Antibiotic therapy
R Dhaker, Lecturer, PCNMS 14

15. Supportive care
• Provide warmth
• Start IV line. Infuse normal saline 10ml/kg over 5
to 10 minute.
• Infuse 10%glucose, 2ml/kg stat to manage
hypoglycemia.
• Administer injection vitamin K, 1mg IM to
prevent bleeding.
• If the baby is cyanosed or grunting provide
oxygen via hood or mask.
R Dhaker, Lecturer, PCNMS 15

16. Cont… Supportive care
• If baby is Apneic provide physical stimulation and
bag – mask ventilation, if required.
• Avoid oral feeding if baby is very sick and given
intravenous fluid.
• In neonates with sclerema, exchange transfusion
with fresh whole blood may be required.
R Dhaker, Lecturer, PCNMS 16

17. Antibiotic therapy
• Antibiotic therapy should cover common
causative bacteria like E.coli, staphylococcus
aureus and klebsiella pneumoniae.
• A combination of ampicillin and gentamycian is
recommended for treatment of sepsis and
pneumonia.
R Dhaker, Lecturer, PCNMS
17

18. Cont…Antibiotic therapy
IN Septicemia and Pneumonia
• Injection Ampicillin 50 mg/kg/dose 12 hourly IV or
IM 7 to 10 days
• Injection Gentamicin 2.5mg/kg/dose BD IV/IM, 7 to
10 days
In Meningitis
• Injection Ampicillin 100 mg/kg/dose 12 hourly IV 3
weeks
• Injection Gentamicin 2.5mg/kg/dose BD IV, 3Weeks
or
• Injection Chloramphenicol 12mg/kg/dose BD IV,
3weeks
R Dhaker, Lecturer, PCNMS 18

19. Prognosis
• The prognosis is variable. Sever neurological and
respiratory problem may occur in low birth weight
babies as a result of early onset sepsis.
• Late onset sepsis and meningitis may result in
poor outcomes.
R Dhaker, Lecturer, PCNMS 19