Diagnosis and Treatment of Sepsis in Newborns

Sepsis is a medical condition wherein the immune system overreacts to an infection, turning the white blood cells against the body’s own cells and tissues. Anyone with a weak immune system is susceptible to sepsis. Neonatal sepsis is the term for this blood condition in babies of less than three months of age.

If left unchecked neonatal sepsis is potentially life threatening to a newborn. Should the symptoms of sepsis be suspected in a baby, the parents should immediately take the baby to a doctor for a timely diagnosis. Treatment is often started immediately to ensure that the condition of the baby does not deteriorate.

Symptoms to Watch Out for Sepsis in Newborns

The most telling symptoms that the newborn is unwell includes a reluctance to feed or drink water for more than 8 hours, and no passing of urine for more than 12 hours. If the baby is shivering and has a fever, there is definitely something wrong. Health care providers must be contacted as soon as the baby seems to display these primary symptoms.

Other signs of neonatal sepsis include pale skin, lethargic movements, problem breathing naturally, bulging of the fontanelle and irritability. Parents should be educated so that they may recognise potential symptoms and then act fast by taking the baby to their health care provider for confirmation and treatment.

Diagnosis of Sepsis in Newborns

The baby will likely have a fever, trouble breathing and an increased heart rate. While the physical examination of the newborn may prove sepsis is suspected, the confirmation will be provided by undergoing diagnostic tests. There are three categories of tests that may be recommended by the health care provider.

Blood Tests

A blood sample will be taken for a blood culture as well as a complete blood count. A high white blood cell count correlates to the condition. A C-reactive protein test may also be performed. The blood tests help identify the type of bacteria or virus causing the sepsis. This helps in ensuring prescribed medication specifically targets the causative agent of the infection.

Laboratory Tests

A urine culture may be done on the baby’s urine to identify the cause of the infection. If the baby is coughing and throws up mucus, the mucus may be tested as well to identify the infection’s cause. Should there be a wound, the secretions from the wound can be used to check what bacteria is causing the infection.

Imaging Scans

A chest X-ray will be taken if the baby has consistent trouble with breathing normally. A Computerized Tomography or C.T. scan may be taken to identify the location of the infection internally. A lumbar puncture or spinal tap could be performed to gain a sample of spinal fluid. This will be tested to check for meningitis, an infection of the membranes that cover the brain. An ultrasound or Magnetic Resonance Imaging (MRI) may be required to study the internal organs affected by the infection in cases of severe sepsis.

Treatment of Neonatal Sepsis

The main focus of the treatment is on combating and flushing out the infection from the newborn baby’s body. This is done by providing an intravenous (IV) fluid laced with antibiotic medication. The procedure is often done even before the diagnostic test results are known as a pre-emptive measure. Once the tests are concluded and the cause of the infection is known, targeted medication will begin.

Should the infection be of a viral nature then acyclovir, an antiviral medicine, is prescribed. The baby may need to be admitted to the hospital during the process of diagnosis and testing. As the baby begins responding to medication and recovering, they may be allowed to return home. The newborn will still need to be brought in to the hospital periodically until the sepsis clears up.

In case of severe neonatal sepsis, should septic shock set in, the baby will require constant monitoring. The main focus will then be on stabilization of the baby’s breathing and heart rate. The IV fluids should increase the blood pressure however if it stays low, then a vasopressor medication that constricts blood vessels and increases blood pressure may also be required.

Prognosis and Outcome

A mild case of neonatal sepsis usually clears up with treatment. The baby will not suffer any longer term problems with development and growth. The child will be at a higher risk for developing fresh infections till the immune system finally strengthens and stabilizes.

The outcome is not as good in case of severe sepsis which has led to septic shock. In these cases there is a 50% chance of the baby surviving as organ failure occurs very fast. The drop in blood pressure leading to low oxygen levels can often prove fatal to the newborn.

Reviewed by Afsaneh Khetrapal BSc (Hons)

References

Further Reading

Last Updated: Jan 19, 2017

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