Sepsis
What is sepsis?Sepsis is a term for severe infection that is present in the
blood and spreads throughout the body. In newborns, it is also called
sepsis neonatorum or neonatal septicemia.
What causes sepsis?Sepsis can develop following infection by microorganisms
including bacteria, viruses, fungi, and parasites. Infection in babies can
be contracted during pregnancy, from the mother's genital tract during
labor and delivery, or after birth from contact with others.
Sepsis in a newborn is more likely to develop when the mother has had
pregnancy complications that increase the likelihood of infection. Such
complications may include the following:
- premature rupture of the membranes (amniotic sac), or membrane
rupture for an extended length of time
- bleeding problems
- a difficult delivery
- infection in the uterus or placental tissues
- fever in the mother
Babies can also develop sepsis by contracting infections after birth
from infected persons or objects. Babies in the newborn intensive care
unit (NICU) are at increased risk for acquiring nosocomial
(hospital-acquired) infections. Many babies in the NICU are premature or
have low birthweight which makes them more susceptible to infection and
more likely to need invasive treatments and procedures. Microorganisms
that normally live on the skin may cause infection if they enter the body
through catheters and other tubes inserted into the baby's body.
What microorganisms cause severe infections and
sepsis in babies?
Why is sepsis a concern?Sepsis can be life threatening for newborns, especially if the
baby has a weakened immune system because of prematurity or another
illness. When a baby's immature immune system cannot fight the
microorganism, the infection can quickly spread and overtake the body,
causing serious illnesses such as meningitis or pneumonia.
What are the symptoms of sepsis?Sepsis in newborns is not always easy to identify since newborn
babies often do not show symptoms of infections in the same way older
babies and children may show symptoms. The following are some of the
symptoms of infection in newborn babies. However, each baby may experience
symptoms differently depending upon the type of organism causing the
infection and the severity and location of the infection. Symptoms of
infection may include the following:
- apnea (stopping breathing) or difficulty breathing
- bradycardia (decreased heart rate)
- decreased temperature or temperature instability
- weak suck
- jaundice (yellow coloring of the skin and eyes)
How is sepsis diagnosed?A sepsis workup may be needed to help identify the location of
the infection and type of microorganism causing the infection. A sepsis
workup may include the following procedures:
- blood tests
- lumbar puncture (Also called spinal tap.) - a special needle is
placed into the lower back, into the spinal canal. This is the area
around the spinal cord. The pressure in the spinal canal and brain can
then be measured. A small amount of cerebral spinal fluid (CSF) can be
removed and sent for testing to determine if there is an infection or
other problems. CSF is the fluid that bathes your child's brain and
spinal cord.
- blood cultures
- urine culture (sometimes by suprapubic tap, insertion of a needle
through the lower abdomen into the bladder)
- culture of fluids from inside tubes and catheters that are inserted
in the baby
- x-rays - a diagnostic test which uses invisible electromagnetic
energy beams to produce images of internal tissues, bones, and organs
onto film.
Procedures may also be performed to determine which antibiotics or
medications are most effective for treating the specific microorganism.
Treatment of sepsis:
Specific treatment for sepsis will be determined by your baby's physician
based on:
- your baby's age, overall health, and medical history
- extent of the disease
- your baby's tolerance for specific medications, procedures, or
therapies
- expectations for the course of the disease
- your opinion or preference
Early diagnosis and treatment of the infection are important in helping
prevent sepsis from overwhelming a baby's body. However, cultures of blood
and body fluids may take several days for the organism to grow and be
identified. Because of this, babies who are at increased risk for sepsis,
such as premature or low birthweight babies, may have preventive
antibiotic treatment started as soon as cultures are taken. Most
medications are given intravenously (IV).
Sepsis can be life threatening as the infection can affect several body
systems at the same time. This can make providing treatment more
difficult. Babies with sepsis will require care in the newborn intensive
care unit (NICU), and may need antibiotics, other medications, and
specialized treatment (such as a mechanical breathing machine). The
healthcare team will be working to provide the best care to treat the
infection and care for your baby.
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