Newborn sepsis is a severe infection in an infant younger than 28 days old. A newborn may become infected before, during, or after birth. Newborn sepsis can be hard to diagnose. Early diagnosis and treatment are the best ways to stop sepsis.

1. Submitted by
Joel Rajan u

2. Neonatal sepsis is a type of neonatal infection and specifically
refers to the presence in a new born baby of a bacterial bloodstream
infection (BSI) (such as meningitis, pneumonia, pyelonephritis,
or gastroenteritis) in the setting of fever

3. Common organisms identified:
 1. Escherichia coli.
 2. Group B Streptococci.
 3. Listeria monocytogenes.
 4.Others - Coagulase negative staphylococci.
Streptococcus pneumoniae. Klebsiella pneumoniae.
Acinetobacter species. Pseudomonas aeruginosa.
Candida

4. Neonatal sepsis include the following:
Congenital infection —major risk factor is maternal infection.
 Early-onset sepsis (birth to 7 days)—transplacental, ascending, or
intrapartum.
manifests as: 1. Pneumonia (Frequently) 2. Less commonly as: Septicaemia ,
Meningitis.
 Late-onset sepsis (8 to 28 days)—acquired in hospital, home, or
community
manifests as: 1.Septicemia. 2.hematogenous seeding may result in focal
infections, such as meningitis (in 75% of cases), osteomyelitis (group B
streptococci, S. aureus), arthritis (gonococcus, S. aureus, Candida albicans,
gram negative bacteria), and urinary tract infection (gram negative bacteria).

5.  • Respiratory distress syndrome (RDS).
 • Metabolic diseases.
 • Hematologic diseases.
 • CNS diseases.
 • Cardiac diseases.
 • Other infections (e.g. TORCH infections).

6.  Respiratory distress in early onset NS.
 Altered feeding behaviour in a well established feeding
new-born (aspiration, vomiting, etc).
 Baby who was active, suddenly or gradually becomes
lethargic, inactive or unresponsive and refuses to suckle.
 Temperature instability: Hypo- or hyperthermia.
 Skin: Poor peripheral perfusion, cyanosis, pallor,
petechiae, rashes, or jaundice.
 Metabolic: Hypo- or hyperglycaemia or metabolic acidosis

7. B. Definitive, specific:
Cultures:
• Blood: Confirms sepsis.
• Urine:
• CSF: May be useful in clinically
ill newborns or those with
positive blood cultures.
C: Radiology
• Chest X-Ray: – For infants
with respiratory symptoms.
• Renal ultrasound: – For
infants with accompanying
UTI.
• CT scan: – For infants with
probable meningitis or
seizures.
A. Non-specific:
• White blood cell count and
differential:
Neutropenia can be a threatening
sign (< 1,800/cmm).
Immature to Total neutrophil (I:T)
ratio ≥ 0.2 is predictive (Normal: ˂
0.16).
• Acute phase reactants:
C-Reactive Protein (CRP): rises
early.
ESR rises > 15 mm 1 st hr.
• Platelet count:
Decreases, a late sign and nonspecific.
• Others: – Bilirubin,

8. • 1. Antibiotics:
Should be based on culture & sensitivity
Antibiotics are used to suppress bacterial growth,
allowing the infant's defence mechanisms time to
respond.
• 1. Antibiotics:
 • A combination of ampicillin and an
aminoglycoside (usually gentamicin) for 10 to 14
days is effective treatment against most
organisms responsible for early-onset sepsis.
 • The combination of ampicillin and cefotaxime
also is proposed as an alternative method of
treatment.
 • If meningitis is present, the treatment should be
extended to 21 days or 14 days after a negative
result from a CSF culture.
• 2. Supportive therapy
In addition, support measures, such as
assisted
ventilation and cardiovascular support, are
equally important to the management of the
infant.
Supportive therapy
• Respiratory: Oxygen and ventilation as
necessary.
• Cardiovascular: Support blood pressure
with
volume expanders.
• Hematologic: Treat DIC.
• CNS: Treat seizures with phenobarbital.
• Metabolic: Correct hypo-/hyperglycaemia
and

10.  A 19-year-old woman, gravida 2, delivered vaginally, a 1.95 kg girl at
34 weeks gestation. She had 6 prenatal consultations and the pregnancy
was uneventful. No intrapartum antibiotics were given. Membranes
ruptured spontaneously six hours before delivery, and there was no
maternal fever.
 The infant was born vigorous with Apgar scores of 8 at one minute and
9 at five minutes.

11.  Mild tachypnoea was noted (The tachypnoea was transient and lasted
only three hours)
 She was pink, active and with good peripheral perfusion
 At 18 hours of age the infant had severe apnoea, mottled skin and
delayed capillary refill time

12.  The clinical course was fulminant, with respiratory failure, severe
metabolic acidosis and profound arterial hypotension unresponsive
to aggressive fluid resuscitation, and high doses of dopamine and
dobutamine

13.  A cell blood count showed leukopenia (2,100 × mm3),
 neutropenia (1,400 × mm3)
 normal platelet count of 265,000 × mm3
 normal C- reactive protein (4 mg/dL).
 A chest radiograph showed a reticulogranular pattern in both lung
fields, which was suggestive of pneumonia.

14.  Neonatal Streptococcus Pneumoniae sepsis
[The infant was pronounced dead at 23 hours of postnatal age]

15.  The blood culture grew penicillin-sensitive Streptococcus
Pneumoniae 28 A serotype.
 Mother’s vaginal swab was also positive for the same bacteria and
serotype.

16.  She was quickly intubated, and placed on mechanical ventilation.
 Umbilical artery and umbilical vein catheters were placed.
 Ampicillin and gentamicin were begun after a blood culture was
obtained.
 Lumbar puncture was not done due to the critical condition of the
infant.

17.  Neonatal Streptococcus Pneumoniae sepsis is uncommon
 high mortality Rate
 more recent reports have shown that most cases occurred during the first week of
life, predominantly within the first 48 hours.
 Early onset infections can be acquired through a colonized birth canal or rarely, by
hematogenous transplacental transmission, secondary to maternal bacteraemia
 In our case the mother’s genital tract was colonized, so most likely, the infant
acquired the infection, through the birth canal
Note: Streptococcus Pneumoniae is not normally present in the vagina, colonization of
the lower genital tract can occur through orogenital contact with a nasopharyngeal
carrier or with a person suffering from acute upper respiratory tract pneumococcal
infection.

18.  In conclusion, strategies to prevent early- onset NSPS are evolving.
Some interventions we think are mandatory, these include treatment for
all pregnant women with a positive vaginal culture to Streptococcus
Pneumoniae, and clinicians’ increased awareness of SPNS and prompt
aggressive antibiotic treatment of affected neonates. Further
surveillance studies, assessment of risk factors for SPNS, as well as
evaluation of other strategies such as vaccination during pregnancy,
aiming to protect these infants are needed

19.  Good antenatal care.
 Maternal infections diagnosed and treated
early.
 Babies should be breastfeed early.
 Infection control policies applied in the unit