2. Pathophysiology
• GBS leads to many different
manifestations including
respiratory distress,
pneumonia, meningitis, and
sepsis/septic shock.
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3. Pathophysiology, cont'd
• Due to the many complications
that can occur with GBS
infection, this section will
focus on the pathophysiology
of sepsis.
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4. How Does Sepsis Start?
• As explained in the pathogenesis
section, early onset GBS is
contracted by infants from
colonized mothers during
pregnancy (in utero) and
childbirth (intrapartum period).
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5. How Does Sepsis Start, cont'd
• GBS effects the respiratory tract
and can enter the bloodstream
causing severe respiratory distress,
pneumonia, and bacteremia.
• Sepsis and septic shock are results
of worsening pneumonia and
bacteremia.
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6. Changes in the Body Leading to Sepsis
• Sepsis begins with the activation of
the immune response, via
recognition of GBS bacteria, by
immune sentinel cells such as
macrophages and monocytes. This
happens when barrier function has
been compromised (Wynn & Wong,
2010).
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7. Changes, cont'd
• In and on cells, pattern recognition
receptors and Toll-like receptors
are activated allowing the
recognition of pathogens, as well
as the initiation of the immune
response (Wynn & Wong, 2010).
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8. Changes, cont’d
• Cytokines and chemokines are
produced and activated to try
and fight the bacterial
invasion.
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9. Changes, cont'd
• Due to the prematurity of newborns
immune systems, production of certain
pro-inflammatory cytokines, macrophages,
leukocytes, and neutrophils are decreased,
thus impairing the accumulation at
inflammation sites and causing systemic
infections due to the lack of recruitment
(Wynn & Wong, 2010).
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10. Changes, cont'd
• In addition, neonates have a dysregulation
of complement activation. Complement is
extremely important in the innate immune
system by increasing leukocyte formation,
assisting in local vascular permeability, and
helping with coagulation and
proinflammatory cytokine production
(Wynn & Wong, 2010).
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11. Changes, cont'd
• GBS can spread throughout the
newborn’s body quickly due to the
capsule property of the bacteria. This
can happen “ before adequate host
clearance mechanisms are recruited”
(Nizet et al., 2000, p. 194).
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12. Cardiovascular Effects
• Neonates with sepsis may have the
following: tachycardia, poor perfusion,
hypotension, vasodilation, pulmonary
hypertension, & hypoxia. These factors
are due to difficulty transitioning from
intrauterine to extrauterine life,
differences in hemodynamic responses,
and the inability to increase stroke volume
and contractility (Wynn & Wong, 2010).
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13. Pulmonary Effects
• Due to decreased oxygen delivery to
tissues, many respiratory complications
can occur in sepsis including: acute
respiratory distress syndrome,
secondary surfactant deficiency,
pulmonary edema, pneumonia, &
persistent pulmonary hypertension
(Wynn & Wong, 2010).
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14. Pulmonary Effects, cont'd
• An immature immune system,
underdeveloped cilia, and
decreased pulmonary
macrophages also contribute to
respiratory complications
(Reuter et al., 2014).
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15. Multi-Organ Dysfunction Syndrome
• Sepsis can lead to septic shock, which
can lead to Multi-Organ Dysfunction
Syndrome (MODS).
MODS occurs with poor cardiac output
and microcirculatory failure leading to
compromised blood flow to all the major
organs including kidneys, liver, gut, and
central nervous system (Wynn & Wong,
2010).
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16. General Course of Sepsis
• Due to many of the factors we have
explored, sepsis in the newborn can
progress very rapidly. Infants can
only compensate for so long before
they get very sick and their status
declines.
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17. General Course of Sepsis, cont'd
• Untreated sepsis often progresses
through:
• Systemic Inflammatory Response
Syndrome (SIRS)
• Severe Sepsis (SIRS with end organ
dysfunction)
• Septic Shock (Severe Sepsis with
hypotension or lactic acid over 4)
• Death
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18. General Course of Sepsis, cont’d
• Morbidities:
• Up to 50% of term infants that acquire
GBS infection leading to sepsis will
suffer from serious complications
including: seizures, blindness,
deafness/hearing loss, and
developmental delays in speech and
language (Simonsen, Anderson-Berry,
Delair, & Davies, 2014).
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19. General Course of Sepsis, cont’d
• Mortality:
• In term infants, mortality of sepsis is
much lower than in the preterm
population. Term infants with
comorbidities, such as impaired immune
functions, cardiac or pulmonary
abnormalities, meconium aspiration, and
galactosemia are at a higher risk of
mortality (Simonsen et al., 2014).
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20. General Course of Sepsis, cont'd
• Mortality, cont'd
• GBS infection and sepsis in the
newborn are acute
complications and failure to
treat sepsis can lead to
neonatal death.
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21. Mitigating Factors-Diet
• Early onset GBS infection occurs
between birth through the first
days of life. Many factors can
affect the first few days of life,
so it is critical to maximize and
enhance newborn immunity.
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22. Diet in the Newborn, cont'd
• The effects of early breastfeeding (<24
hours after birth) has shown many
benefits to infants, such as protecting
against infectious diseases and
illnesses including sepsis, pneumonia,
and meningitis (Debes, Kohli, Walker,
Edmond, & Mullany, 2013).
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23. Diet in the Newborn, cont'd
• In a systematic research review
conducted by Debes et al.
(2013), there was a lower risk of
morality associated with infants
who had early initiation of
breastfeeding.
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24. Diet in the Newborn, cont’d
• By initiating early breastfeeding, the risk of
infection is decreased due to ingesting
nutrient and antibody rich colostrum, as
well as a decrease in the ingestion of
infectious pathogens. Colostrum exposes
infants to important immunoglobulins and
lymphocytes, which stimulates the
humoral/cell mediated immune system,
helping with immune responses (Debes et
al., 2013).
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25. Diet in the Newborn, cont’d
• In addition, early breastfeeding primes
the gastrointestinal tract, decrease
intestinal permeability, and promotes
skin to skin contact (Debes et al., 2013).
• Decreased intestinal permeability can
help to prevent the inflammatory
cascade, the breakdown of tight
junctions, and bacteria formation all
associated with leaky gut.
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26. Diet in the Newborn, cont'd
• Skin to skin contact during
breastfeeding stimulates the mucosa-
associated lymphoid tissue MALT)
system (Debes et al., 2013, p. 11). The
MALT contains immune system
important lymphocytes, which help to
protect the body from antigens.
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27. In Conclusion…
• Sepsis is a serious and life threatening
complication associated with GBS
infection.
Due to the multifactorial nature of neonates’
immature systems, a cascade of
complications can occur in every body
system.
Initiating early breastfeeding can help
enhance the newborn’s immune system.
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28. References
• Please see the "References"
section on the main Group
Beta Streptococcus (GBS)
WikiSpaces page.
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