Neonatology
Sepsis
Newborn infants, particularly those who are premature,
have immune systems that are not yet fully developed
and are more susceptible to developing infections.
Bacteria may enter the body through the mouth
or nose, or through the skin in extremely premature
babies. Endotracheal
tubes, intravenous
lines, and central
catheters are additional sites where bacteria
may enter the body. Although every effort is made
to care for equipment in a sterile manner, the
possibility of an infection cannot be eliminated
completely. If an infection is systemic, this
is referred to as sepsis. In infants, even localized
infections, such as those involving the lungs
or skin, can become systemic and travel to other
sites in the body.
Signs of infection in an infant may include:
- Lethargy
- Temperature instability
- High or low blood sugar
- Increasing numbers of apneas and bradycardias
- High heart rate
- Poor skin color
- Need for increasing ventilator support
- Feeding intolerance
We are always alert for any signs of infection.
If an infection is suspected, a "sepsis
workup" will be done, which includes
a complete
blood count (CBC), C-reactive
protein (CRP; a protein in the blood which
may become elevated in response to infection),
and blood culture. A lumbar
puncture (spinal tap) may also be done since,
if sepsis is present, there may also be a risk
for developing meningitis.
Treatment
After the blood tests have been drawn, antibiotics
will be started. The duration of antibiotic therapy
depends on the condition of the infant and the
results of tests. If the blood culture is positive,
then this confirms the presence of bacteria in
the blood, and antibiotics will be continued for
at least seven days. A negative blood
culture does not exclude the presence of sepsis
with complete certainty, so antibiotics may be
given for three days or longer.
Congenital and Nosocomial Infections
Infants may be born with sepsis (congenital infection),
or may develop it later in the hospital (nosocomial
infection). Congenital sepsis may be caused by
a variety of bacteria, including Group B Streptococcus
(GBS), a bacterium with which women are often
colonized normally. If a mother is known to be
GBS positive, or if the GBS status is unknown,
then the infant will receive a "sepsis screen"
following delivery consisting of a CBC and CRP
to evaluate for the presence of infection. If
the newborn appears ill, or if the sepsis screen
results are significantly abnormal, then a sepsis
work-up will be done and intravenous antibiotics
will be started.
Nosocomial infections can be caused by a wide
variety of organisms in the environment. If a
nosocomial infection is suspected, broad-spectrum
antibiotic therapy will be started. If the blood
culture is positive, then the exact bacteria can
be identified, and the antibiotics used can be
tailored to treat the specific organism(s).
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