Neonatal sepsis is a significant cause of mortality in newborns, particularly in Africa, accounting for 18-35% of deaths due to its nonspecific symptoms. It can manifest as early or late-onset sepsis, and diagnosis involves clinical assessment, blood cultures, and other laboratory tests. Treatment typically involves broad-spectrum intravenous antibiotics, and complications can include septic shock and respiratory failure.

1. NEONATOLOGY III
NEONATAL SEPSIS
Dr Ugolee Jerry

2. INTRODUCTION
• Neonatal sepsis refers to the presence of a bacterial blood
stream infection in a newborn.
• It is the single most common cause of death among neonates
accounting for 18-35% of neonatal mortality in Nigeria and
other parts of Africa.
• Neonatal sepsis maybe difficult to exclude when presenting
with non-specific symptoms and signs and in the absence of
localizing clinical features such as seen in meningitis,
pneumonia or gastroenteritis.

3. INTRODUCTION
• NNS must be clinically excluded in a newborn presenting
with fever( defined as temp 38°C).
˃
• NNS maybe described as early-onset sepsis(EOS) when
occurring in the first 7days of life or late-onset sepsis when
presenting after 7days.
• It may also be referred to as a ‘risk for sepsis’ when a
newborn has no clinical manifestations but has been exposed
to risk factors for neonatal infection e.g. PROM, prolonged
labour, chorioamonitis, prematurity, peripatal pyrexia.

4. INTRODUCTION
• ‘Presumed sepsis’ when a newborn who is at risk for
neonatal infection develops clinical signs and symptoms of
sepsis e.g. fever or hypothermia, poor suck, reduced activity,
a haemorrhagic/pustular rashes, tachycardia.
• ‘Probable sepsis’ when a newborn with clinical
manifestations of sepsis returns a FBC result suggestive of
sepsis.
• ‘Confirmed sepsis’ when a newborn with clinical
manifestations of sepsis returns a positive blood culture result

5. AETIOLOGY
• Common organisms that have been cultured from blood of
affected neonates are mostly organisms that colonize the
female genitourinary tract.
• They include Gram-positive bacteria like Staph aureus, Staph
epidermis, Strep pyogenes and Group B Streptococcus.
• Gram-negative bacteria like E. coli, Klebsiella sp. Proteus sp.
Listeria monocytogenes.
• Antibiotic treatment used in the treatment of NNS commonly
targets these organisms.

6. RISK FACTORS
• Risk factors for NNS include:
• PROM
• Peripatal Pyrexia in mother
• Prematurity
• Prolonged labour
• Instrumental delivery
• APH
• Chorioamnionitis

7. CLINICAL FEATURES
• Temperature instability
• Poor suck
• Irritability(excessive unconsolable cry)
• Reduced activity
• Vomiting
• Pustural rashes
• Unexplained hyperbilirubinemia
• Seizures
• Eye discharge

8. DIAGNOSIS
• Do a septic work up
• FBC with peripheral blood film – Neutropenia or leucocytosis
with left-shift and immature neutrophils & band forms.
• Blood culture
• Acute phase reactants- increased ESR, CRP, haptoglobulin
• Urine m/c/s
• CSF m/c/s
• Wound swabs & m/c/s

9. DIAGNOSIS
• Detailed history taking – ask for prenatal, perinatal and
intrapartum risks for sepsis.
• Do thorough physical examination
• Persistent tachycardia and breathing problems
• Systemic signs (bulging anterior fontanel, ear tugging,
diarrhoea, crepitations.)

10. TREATMENT
• Have a high index of suspicion as symptoms and signs may
be non-specific.
• IV antibiotics broad spectrum with good gram-negative
coverage ( Ampicillin + genticin as 1st
line, 2nd
and 3rd
generation cephalosporin's + Genticin as 2nd
line)
• Ceftriaxone or Ceftazidime are commonly used in many
centres. Give for 5-7days.
• Other options meropenem, vancomycin, ciprofloxacin.

11. COMPLICATIONS
• Septic shock
• MODS
• Respiratory failure
• Hyperbilirubinemia
• SIADH
• Hypoglycemia
• Dyselectrolytemia (metabolic acidosis, hyperkalaemia)