Recognising Neonatal Sepsis
Published: 28 March 2021
Published: 28 March 2021
Sepsis is a leading cause of mortality in neonates, estimated to occur in one to eight out of every 1,000 births. (WHO 2020; Better Safer Care 2021).
With a relatively weak immune system, newborn infants less than 28 days old are particularly vulnerable to infection entering the bloodstream and causing sepsis.
It’s a condition that not only causes significant morbidity and mortality but one that remains stubbornly difficult to diagnose and treat.
There are two categories of neonatal sepsis based on the time of presentation after birth:
(Better Safer Care 2021)
EOS is a potentially fatal condition associated with birth canal organisms that are acquired in utero or during delivery (LaMonica 2020). According to Strunk et al. (2018), EOS affects about 0.3 to 0.8 of every 1,000 infants born at or after 35 weeks gestation in developed countries.
Typically, EOS is acquired from the mother and usually presents after either:
(Vera 2019)
Both term and preterm infants with EOS present with respiratory distress, which can progress quickly to multisystem involvement within the first 24 hours of life (LaMonica 2020).
LOS is acquired after delivery and typically presents after the first 48 hours of life (Better Safer Care 2021). Infection is caused by nosocomial acquired microorganisms (LaMonica 2020) and is seen more commonly in premature and low birth weight (LBW) infants.
Late-onset sepsis is usually acquired in one of the following ways:
(Vera 2019)
Neonates are susceptible to infections during the perinatal period due to the immaturity of their immune systems (LaMonica 2020).
(LaMonica 2020; Better Safer Care 2021)
(LaMonica 2020; Better Safer Care 2021)
General risk factors that may predispose an infant to infection include:
(LaMonica 2020)
(Better Safer Care 2021)
(Better Safer Care 2021)
Rapid recognition of sepsis is crucial, as if left untreated it can lead to serious consequences (Better Safer Care 2021).
However, while it is important to identify even subtle signs, avoid over-diagnosing. In most cases, an infant with a fever does not have sepsis (RCHM 2020).
Note that the signs of neonatal sepsis may appear non-specific, as they are clinically similar to the symptoms of other conditions such as cardiac or respiratory failure and metabolic disorders (Better Safer Care 2021).
General signs |
|
Respiratory signs |
|
Cardiovascular signs |
|
Cutaneous signs |
|
Gastrointestinal signs |
|
Central nervous system signs |
|
(Better Safer Care 2021)
Despite medical advances, neonatal sepsis remains a leading cause of neonatal mortality. Early recognition, diagnosis and treatment of this serious infection remains a challenge, yet prompt and skilful management is essential to avoid the risk of permanent morbidity or mortality (Rozensztrauch et al. 2018).
Singh et al. (2020) suggest that although specific treatment regimes for neonatal sepsis differ based on various risk factors, empiric treatment with antibiotics should generally be started as soon as sepsis is clinically suspected, even before confirmatory laboratory data becomes available. With mortality rates that are inversely proportional to gestational age, preterm infants are particularly vulnerable and often suffer impaired neurodevelopment or vision impairment.
To date, no effective treatments exist for sepsis beyond antimicrobials and supportive care. With no guaranteed means of early recognition or diagnosis, antibiotics tend to be given as soon as a case of early-onset sepsis is suspected. Yet, as Wynn and Polin (2017) point out, this policy may lead to potential harm, as unnecessary exposure to antibiotics can increase the risk of subsequent short-term and long-term problems. They go on to say that although clinical suspicion is required to detect sepsis, less than 9% of blood cultures yield a bacterial pathogen.
Delaying treatment can have devastating consequences, yet the early and accurate diagnosis of sepsis is difficult and often has limited accuracy. It’s only as time progresses and laboratory results become available that the management of this challenging condition can be refined.
General tests |
|
Infection-related tests |
|
Tests to identify the infective organism |
|
(Better Safer Care 2021)
Today, sepsis remains a significant contributor to morbidity and mortality in neonates (Singh et al. 2020).
Infection rates have shown modest reductions in recent years, likely due to ongoing quality improvement measures within the neonatal unit. Despite this, there have been minimal improvements in clinical management, outcomes and accuracy of diagnostic testing options over the last three decades (Wynn 2016).
It’s possible that future research will help identify clear early warning signs that can lead to a formal diagnosis, but for now, many challenges remain in both the diagnosis and management of sepsis in the neonate.
Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date. See Educator Profile
Anne is a freelance lecturer and medical writer at Mind Body Ink. She is a former midwife and nurse teacher with over 25 years’ experience working in the fields of healthcare, stress management and medical hypnosis. Her background includes working as a hospital midwife, Critical Care nurse, lecturer in Neonatal Intensive Care, and as a Clinical Nurse Specialist for a company making life support equipment. Anne has also studied many forms of complementary medicine and has extensive experience in the field of clinical hypnosis. She has a special interest in integrating complementary medicine into conventional healthcare settings and is currently an Associate Tutor, lecturing in Health Coaching and Medical Hypnosis at Exeter University in the UK. As a former Midwife, Anne has a natural passion for writing about fertility, pregnancy, birthing and baby care. Her recent publications include The Health Factor, Coach Yourself To Better Health and Positive Thinking For Kids. You can read more about her work at www.MindBodyInk.com. See Educator Profile