Jennifer has taught Nursing in ADN, BSN, and MSN programs and has a Master's degree in Nursing Education.
Sepsis is not exclusive to one type of person or problem. Sepsis usually refers to a harmful bacteria or toxin being present in the body. Neonatal sepsis refers to harmful bacteria or toxin being present in the neonate. The neonatal time period is defined as any infant less than four weeks old. This includes infants born prematurely.
The are many physical and chemical barriers throughout the human body to protect us from infection. These barriers are in place when the newborn is born. However, the barriers are functioning at a severe deficit and are therefore not adequately protecting the newborn from illness and harm. Skin is the largest barrier and is also the first line of defense when fighting infection. Skin and mucous membranes are broken down more easily in the premature infant. Neonates who are ill, premature or both are at additional risk because of the invasive procedures that breach their physical barriers to infection.
Several organisms and risks factors exist that can cause sepsis in the neonate. The most common organisms that lead to sepsis include:
- Group B Streptococcus (GBS)
- Escherichia coli
- Coagulase-negative Staphylococcus
- Haemophilus influenzae
- Listeria monocytogenes
In addition to specific organisms, there are several risk factors that may predispose a neonate to sepsis. Risk factors are based on the type of sepsis. These risk factors can give neonatologists important clues to the level of stress and illness the fetus had to ensure during the delivery process, as well as the hazardous uterine environment surrounding the fetus before delivery. Early-onset, late-onset, and antibiotic-resistant are the most common types of sepsis.
Types of Neonatal Sepsis
Early-onset neonatal sepsis refers to the presence of a sepsis infection within the first 72 hours of birth for the premature, hospitalized neonate. Early-onset neonatal sepsis is most commonly associated with GBS. However, early-onset sepsis caused by E. coli is the most fatal. Early-onset sepsis is associated with the following risk factors as well:
- Maternal GBS colonization (especially if untreated during labor)
- Premature rupture of membranes (PROM)
- Preterm rupture of membranes
- Prolonged rupture of membranes (greater than 18 hours)
- Maternal urinary tract infection
- Low Apgar score (< 6 at 1 or 5 minutes)
- Maternal fever greater than 38°C
- Maternal urinary tract infection (UTI)
- Poor or no prenatal care
- Poor maternal nutrition
- Low socioeconomic status
- African American mother
- History of recurrent abortion
- Maternal substance abuse
- Low birth weight
- Meconium staining
- Congenital anomalies
Late-onset sepsis is sepsis occurring within 4-90 days of life and is often associated with the environment in which the neonate exists in. It is often associated with the following risk factors:
- Central venous catheterization (duration >10 days)
- Nasal cannula or continuous positive airway pressure (CPAP) use
- H 2 -receptor blocker or proton pump inhibitor (PPI) use
- GI tract pathology such as necrotizing enterocolitis (NEC)
The incidence of neonatal sepsis in the United States is approximately 2 per 1,000 live births according to the Centers for Disease Control and Prevention (CDC). Of those neonates who are suspected to have and are evaluated for sepsis, only a handful will actually have culture-proven sepsis. However, despite these numbers, many physicians feel it is best to treat the neonate as if he or she is positive. This is due largely in part to the fact that early signs of sepsis are nonspecific. The American Academy of Pediatrics (AAP), the American Academy of Obstetrics and Gynecology (AAOG), and the CDC all have recommended sepsis screening or treatment for various risk factors even if the child is asymptomatic. Again, this is due to the fact that the non-specific symptoms can lead to sepsis and potentially death. Mortality rates from untreated sepsis are as high as 50%. Most physicians feel this is too risky and prefer to be safe than sorry.
In summary, sepsis by basic definition is a serious infection that can invade the human body from any aspect. Neonatal sepsis is when this serious condition is present in a neonate. Neonates are at an increased risk for this infectious process because they are premature weakening the body's natural defense mechanisms. Increased stress, as well as maternal risk factors and certain risk factors during the delivery, can increase the incidence of sepsis. Sepsis in anyone, big or small, is a very serious issue and can have life-altering effects. Due to the severity and increased risk factors present in the neonate, physicians believe it is best to treat this illness or the possibility of this illness right away.
Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.
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