Neonatal sepsis is a systemic bacterial infection occurring in newborns, especially preterm and low birth weight babies, and is a major cause of mortality and morbidity. It can be classified as early-onset (before 72 hours of life) or late-onset (after 72 hours) depending on the timing of symptoms. Common causes include E. coli, Staphylococcus aureus, and Klebsiella species. Treatment involves early recognition, appropriate antibiotic therapy, and optimal supportive care such as maintaining temperature and blood pressure. With prompt diagnosis and aggressive management, most cases of neonatal sepsis can be successfully treated.

1. Neonatal Sepsis

2. Definition
• When pathogenic organisms gain access into the blood stream, they
may cause an overwhelming infections without much localization
(septicemia), or may get predominantly localized to lungs
(pneumonia) or the meninges (meningitis)
• Systemic bacterial infections are known by the generic term Neonatal
sepsis (NNS)
• It is one of the most important causes of mortality and morbidity in
newborn(especially in preterm, LBW babies).

3. Etiology
• E coli, Staph Aureus and klebsiella speicies are the predominant
organims.
• Organisms like acinetobactor, pseudomonas and coagulase negative
staphylococci are also important pathogens in hospital acquired
infections

4. Incidence
• According to NNPD
• incidence of neonatal sepsis is about 30 per 1000 live births
• incidence of mortality due to NNS is about 4.1 %
• If diagnosed early and treated aggressively with antibiotics & good
supportive care, most cases of neonatal sepsis can be saved.

5. Classifications
Neonatal sepsis can be classified into two sub-types depending upon
time of onset of symptoms
A. Early onset neonatal sepsis
B. Late onset neonatal sepsis

6. Early-onset NNS
• Occurs before 72 hrs of life
• Mainly due to bacteria acquired before and during delivery i.e by
organisms prevalent in genital tract or in the labor room or O.T
• Predisposing factors: LBW, PROM, foul smelling liquor, multiple per
vaginal examinations, maternal fever, difficult or prolonged labor and
aspiration of meconium
• EON frequently manifests as pneumonia and less commonly as
septicemia and meningitis

7. Late-onset NNS
• Occurs after 72 hrs of life
• Caused by the organisms thriving in the external environment of the
home or the hospital
• The infections is often transmitted through the hands of the care
providers
• The presentation is that of septicemia, pneumonia or meningitis
• The predisposing factors include: LBW, lack of breast feeding, poor
cord care, superficial infections (pyoderma, umbilical sepsis),
aspiration of feeds and disruptions of skin integrity with needle pricks
and use of IV fluids

8. Clinical features
• C/fs

9. Investigations
• No investigation is required to start treatment in a sick baby who has high
probability of sepsis.
• Blood culture provides definitive diagnosis of NNS and should be taken before
antimicrobial therapy
• Sepsis screening should be done in equivocal cases and it includes:
a) TLC <5000/mm3
b) Absolute neutrophil count <1800/mm3
c) Immature to total neutrophil ratio (I/T ratio) > 20%
d) Micro ESR 15mm or more in the first hour
Sepsis screen is considered positive if two of these parameters are positive
• Lumbar puncture should be performed in all cases of suspected NNS except in asymptomatic babies being
for maternal risk factors

10. Look for other biochemical abnormalities
• Blood glucose
• Blood urea
• Serum creatinine
• TSB
• Serum electrolytes
• ABG

11. Evaluation of extent of the disease
• LP for meningitis
• Urine examinations
• CXR
• Xray erect abdomen
• Stool for occult blood Bone scan

12. Approach to
neonate
suspected of
sepsis

13. Management
Early recognition
+
Appropriate antibiotic therapy
+
Optimal supportive measures

14. Supportive care
• Provide warmth; ensure normal temperature (36.5 to 37.5 celsius)
• Strart oxygen by hood or mask if baby is cyanosed or grunting
• Provide bag and mask ventilation if breathing is inadequate
• Instilling normal saline drops in nostril may help clear the nasal block
• Assess peripheral perfusion (CRT, skin color and peripheral pulses)
• Infuse NS or RL 10ml/kg over 5-10mins, if perfusion is poor; repeat the same
1-2 times over next 30-45mins, if perfusion continues to be poor
• Dopamine and dobutamine may be required to maintain normal perfusion
• If hypoglycemia is suspected give glucose 10% 2ml/kg stat

15. Specific care
• Combination antibiotics covering most of the pathogens to be started initially.
• Aminoglycoside + ampicillin.
• Cephalosporins, vancomycin, impinem reserved for life threatening infections
and meningitis.
• In centers with high incidence of resistance to cephalosporins, start
piperacillin-tazobactum/methicillin-vancomycin.
• Newer antibiotics -> aztreonam, meropenem.
• Infections due to ESBL organisms should be treated with meropenem.
• If meningitis -> cefotaxime/ceftazidime + amikacin.

16. • If etiological agent identified or highly suspected based on clinical
picture -> start highly specific antibiotic
• GBS – ampicillin or benzyl penicillin
• E .coli, Klebsiella – cefotaxime or ampicillin + gentamicin
• Listeria – ampicillin + gentamicin
• Enterobacter, serratia - piptaz or vancomycin+gentamicin
• Enterococcus – ampicillin or vancomycin + gentamicin
• Pseudomonas – ceftazidime or cefepime

17. Monitoring
• Intensive care and monitoring is the key determinant of the improved
survival of neonates
• The elements of monitoring in sepsis are not different from those in
other life threatening conditions
• Proper monitoring of sick babies enables care providers detections of
complications at the earliest

18. Prognosis
• The outcome depends upon
• weight and maturity of the infant
• Type of etiologic agent
• Its antibiotic sensitivity pattern
• Adequacy of specific and supportive care

19. • Thank you