- Overview of Infections in Newborns
- Sepsis in Newborns
- Hospital-Acquired Infections in Newborns
- Pneumonia in Newborns
- Bacterial Meningitis in Newborns
- Listeriosis in Newborns
- Conjunctivitis in Newborns
- Herpes Simplex Virus (HSV) Infection in Newborns
- Hepatitis B Virus (HBV) Infection in Newborns
- Cytomegalovirus (CMV) Infection in Newborns
- Rubella in Newborns
- Syphilis in Newborns
- Toxoplasmosis in Newborns
- Tuberculosis (TB) in Newborns
Sepsis is a serious bodywide reaction to infection spread through the blood.
Topic Resources
Newborns with sepsis appear generally ill—they are listless, do not feed well, often have a gray color, and may have a fever or a low body temperature.
The diagnosis is based on the symptoms and the presence of bacteria, a virus, or a fungus in the blood, urine, or spinal fluid.
Treatment involves antibiotics and supportive treatments such as intravenous fluids, blood and plasma transfusions, assistance with breathing (sometimes with a mechanical ventilator), and medications to support blood pressure.
Infection in the bloodstream may spread to the tissues covering the brain and the brain itself (meningitis).
(See also Overview of Infections in Newborns and Sepsis, Severe Sepsis, and Septic Shock.)
Sepsis is more likely to occur in
Fetuses whose amniotic fluid leaks any time before labor starts (called prelabor rupture of the membranes)
Newborns whose mother had an infection while pregnant or developed a fever after delivery
Infants who are born prematurely
Infants who have a low birth weight
Infants who have a low APGAR score, required resuscitation at birth, or both
Males
Infants whose mother has a low socioeconomic status are at increased risk of developing the infection and dying of it.
Other risk factors for and causes of sepsis differ depending on when sepsis develops. The start (onset) is categorized as
Early-onset sepsis: Develops before the newborn is 3 days old
Late-onset sepsis: Develops after the newborn is 3 days old or older
Preterm infants are at much higher risk of both early-onset and late-onset sepsis than are infants born at full term because of their immature immune system. Preterm newborns lack certain protective antibodies against specific bacteria because they were born before they could receive them from their mother.
Early-onset sepsis
Newborns can develop early-onset sepsis if they are exposed to certain kinds of bacteria or viruses during birth and delivery. The risk of sepsis is greater if
The water breaks (fluid-filled membranes that surround the fetus rupture) more than 18 hours before birth.
The mother has an infection (particularly of the urinary tract or lining of the uterus) (such as chorioamnionitis).
The mother has group B streptococcus (GBS) bacteria.
The fetus is delivered prematurely.
The most common types of bacteria causing sepsis in the newborn around the time of birth and delivery are Escherichia coli and GBS, which are usually acquired during passage through the birth canal during a vaginal delivery.
Certain viral infections, such as widespread herpes simplex, enterovirus, adenovirus, or respiratory syncytial virus, may cause early-onset sepsis.
Late-onset sepsis
Newborns can develop late-onset sepsis if they are exposed to certain kinds of bacteria or viruses in the hospital.
The main risk factor for late-onset sepsis is
Other risk factors include
Prolonged use of catheters in arteries, veins, and/or the bladder
Antibiotic use in the newborn
Use of a breathing tube inserted through the newborn's nose or mouth (endotracheal tube) and attached to a machine that helps air get in and out of the lungs (ventilator) to help support breathing
Prolonged hospitalization
Sepsis that occurs later is more likely to be acquired from organisms in the newborn's environment, including through or around catheters (a tube doctors use to get fluids or medications into the newborn's bloodstream, such as an IV, or a tube used to drain urine from the newborn's bladder) and other medical equipment, rather than organisms acquired from the birth canal. Newborns who are given antibiotics may develop a yeast infection (candidiasis) because the antibiotics kill the bacteria that normally reside in the body, allowing the yeast Candida to grow unchecked and cause an infection.
Certain viral infections, such as widespread herpes simplex, enterovirus, adenovirus, or respiratory syncytial virus, may cause late-onset sepsis.
Symptoms of Sepsis in Newborns
Newborns with sepsis are usually listless, do not feed well, and often have an unstable body temperature (too hot or too cold). A fever that lasts for more than an hour is not common, but, when present, typically indicates the newborn has an infection.
Other symptoms may include trouble breathing (respiratory distress), pauses in breathing (apnea), poor skin circulation, with cool extremities, abdominal swelling, vomiting, diarrhea, seizures, jitteriness, and jaundice.
Early-onset group B streptococcus (GBS) infection may cause pneumonia.
Other symptoms occur depending on which organism is causing the infection.
Complications of sepsis
One of the most serious complications of late-onset sepsis is infection of the membranes surrounding the brain (meningitis). Newborns with meningitis may have extreme sluggishness (lethargy), coma, seizures, or bulging of the soft spot between the skull bones (fontanelle). Meningitis is often fatal if not treated promptly.
Diagnosis of Sepsis in Newborns
Cultures of blood and sometimes urine
Spinal tap with culture of the spinal fluid
Doctors diagnose sepsis based on the newborn’s symptoms and the results of tests. Doctors do several tests, including blood tests, to try to determine the specific bacterium, virus, or fungus that is causing the infection.
A blood culture, sometimes a urine culture, and a spinal tap (lumbar puncture) are also done. For cultures, doctors take samples of blood, spinal fluid, and urine and try to grow (culture) the bacteria in the samples in the laboratory and identify it.
Newborns with breathing problems undergo a chest x-ray.
Treatment of Sepsis in Newborns
Antibiotics by vein (intravenously)
Sometimes a ventilator or other treatments
While awaiting blood culture results, doctors give strong antibiotics intravenously to newborns with suspected sepsis. Once they identify the specific organism, they may adjust the type of antibiotic.
In addition to antibiotic therapy, other treatments may be needed, such as use of a machine that helps with breathing (mechanical ventilator), intravenous fluids, blood transfusions and plasma transfusions, and medications that support blood pressure and circulation.
Prognosis for Sepsis in Newborns
Early-onset sepsis is fatal in approximately 18% of newborns. Late-onset sepsis is fatal in up to 12% of newborns.
Newborns who recover from sepsis generally do not have long-term problems. One notable exception is newborns who survive meningitis.
Prevention of Sepsis in Newborns
Group B streptococcus (GBS) was the leading cause of early-onset sepsis until screening of all pregnant people for GBS became a routine part of prenatal care in many countries.
If screened pregnant people have GBS or if they previously gave birth to a newborn who had a GBS infection, they are given antibiotics when they go into labor or the membranes rupture. Antibiotics are not given to pregnant people who have a cesarean delivery (c-section) before labor starts and before membranes rupture.
Although the newborn may require additional monitoring in the hospital and possibly blood tests to check for infection, newborns are given antibiotics only if they have symptoms or signs of infection.
