Learn About Neonatal Sepsis

What is the definition of Neonatal Sepsis?

Neonatal sepsis is a blood infection that occurs in an infant younger than 90 days old. Early-onset sepsis is seen in the first week of life. Late onset sepsis occurs after 1 week through 3 months of age.

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What are the alternative names for Neonatal Sepsis?

Sepsis neonatorum; Neonatal septicemia; Sepsis - infant

What are the causes of Neonatal Sepsis?

Neonatal sepsis can be caused by bacteria such as Escherichia coli (E coli), Listeria, and some strains of streptococcus. Group B streptococcus (GBS) has been a major cause of neonatal sepsis. However, this problem has become less common because women are screened during pregnancy. The herpes simplex virus (HSV) can also cause a severe infection in a newborn baby. This happens most often when the mother is newly infected.

Early-onset neonatal sepsis most often appears within 24 to 48 hours of birth. The baby gets the infection from the mother before or during delivery. The following increase an infant's risk of early-onset bacterial sepsis:

  • GBS colonization during pregnancy
  • Preterm delivery
  • Water breaking (rupture of membranes) longer than 18 hours before birth
  • Infection of the placenta tissues and amniotic fluid (chorioamnionitis)

Babies with late-onset neonatal sepsis are infected after delivery. The following increase an infant's risk for sepsis after delivery:

  • Having a catheter in a blood vessel for a long time
  • Staying in the hospital for an extended period of time
What are the symptoms of Neonatal Sepsis?

Infants with neonatal sepsis may have the following symptoms:

  • Body temperature changes
  • Breathing problems
  • Diarrhea or decreased bowel movements
  • Low blood sugar
  • Reduced movements
  • Reduced sucking
  • Seizures
  • Slow or fast heart rate
  • Swollen belly area
  • Vomiting
  • Yellow skin and whites of the eyes (jaundice)
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What are the current treatments for Neonatal Sepsis?

Babies younger than 4 weeks old who have fever or other signs of infection are started on intravenous (IV) antibiotics right away. (It may take 24 to 72 hours to get lab results.) Newborns whose mothers had chorioamnionitis or who may be at high risk for other reasons will also get IV antibiotics at first, even if they have no symptoms.

The baby will get antibiotics for up to 3 weeks if bacteria are found in the blood or spinal fluid. Treatment will be shorter if no bacteria are found.

An antiviral medicine called acyclovir will be used for infections that may be caused by HSV. Older babies who have normal lab results and have only a fever may not be given antibiotics. Instead, the child may be able to leave the hospital and come back for checkups.

Babies who need treatment and have already gone home after birth will most often be admitted to the hospital for monitoring.

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What is the outlook (prognosis) for Neonatal Sepsis?

Many babies with bacterial infections will recover completely and have no other problems. However, neonatal sepsis is a leading cause of infant death. The more quickly an infant gets treatment, the better the outcome.

What are the possible complications of Neonatal Sepsis?

Complications may include:

  • Disability
  • Death
When should I contact a medical professional for Neonatal Sepsis?

Seek medical help right away for an infant that shows symptoms of neonatal sepsis.

How do I prevent Neonatal Sepsis?

Pregnant women may need preventive antibiotics if they have:

  • Chorioamnionitis
  • Group B strep colonization
  • Given birth in the past to a baby with sepsis caused by bacteria

Other things that can help prevent sepsis include:

  • Preventing and treating infections in mothers, including HSV
  • Providing a clean place for birth
  • Delivering the baby within 12 to 24 hours of when the membranes break (Cesarean delivery should be done in women within 4 to 6 hours or sooner of membranes breaking.)
What are the latest Neonatal Sepsis Clinical Trials?
Topical Coconut Oil Application and Incidence of Sepsis in Neonates

Summary: The randomized control trial aims to determine the effect of twice daily application of a commonly used coconut oil to the skin of neonates in the neonatal intensive care setting on the rate of late onset sepsis versus a no treatment control.

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Pentoxifylline Dose Optimization in Preterm Neonatal Late Onset Sepsis

Summary: Sepsis is a very important cause of death and morbidity in preterm infants. There are strong indications that preterm neonates with sepsis could benefit, next to antibiotics, from treatment with pentoxifylline (PTX). Knowledge about optimal dosing is however limited. This study is a dose optimization study using a step-up and step-down model. In order to find the optimal dose, the infusion of pent...

What are the Latest Advances for Neonatal Sepsis?
Supplementation with a probiotic mixture accelerates gut microbiome maturation and reduces intestinal inflammation in extremely preterm infants.
Management of Preterm Premature Rupture of Membranes in the Late Preterm Period.
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Simultaneous pharmacokinetic/pharmacodynamic (PKPD) assessment of ampicillin and gentamicin in the treatment of neonatal sepsis.
Who are the sources who wrote this article ?

Published Date: May 24, 2021
Published By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Esper F. Postnatal bacterial infections. In Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 48.

Greenberg JM, Haberman B, Narendran V, Nathan AT, Schibler K. Neonatal morbidities of prenatal and perinatal origin. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 73.

Korang SK, Safi S, Nava C, et al. Antibiotic regimens for early-onset neonatal sepsis. Cochrane Database Syst Rev. 2021;5(5):CD013837. PMID: 33998666 pubmed.ncbi.nlm.nih.gov/33998666/.

Polin R, Randis TM. Perinatal infections and chorioamnionitis. In Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 25.

Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion Summary, Number 797. Obstet Gynecol. 2020;135(2):489-492. PMID: 31977793 pubmed.ncbi.nlm.nih.gov/31977793/.