Neonates are more prone to infection. This topic is about the Neonatal Infection and Sepsis with their definition, classification, clinical features, major causes of infections, risk factors, prevention treatment etc. feel free to ask any questions in the comment section. You can made power point presentation shortly known as ppt or Save the Page as PDF for future use. It is also known as Sepsis neonatorum or Neonatal septicemia.

Neonatal Sepsis:

Neonatal sepsis is a bacterial infection in the blood in infants during the first month of life OR in an infant younger than 90 days old.

Classification of Neonatal Infections:

Superficial infections:

Conjunctivitis
Skin sepsis
Paronychia
Umbilical infection
Candida infection
Oral thrush
Perineal candidiasis

Systemic infections:

Neonatal sepsis
Meningitis
Pneumonia
UTI
Osteomyelitis/septic arthritis
Diarrhoea
Neonatal tetanus

Congenital Infections (TORCHS-To Remember):

Congenital syphilis
Toxoplasmosis
Other agents ( Varicella Zoster, HIV, Hepatitis B virus, N gonorrhea, M tuberculosis, Chlamydia trachomatis)
Rubella, CMV, Herpes simplex.

Classification of Neonatal Sepsis:

Early onset is caused by an infection transferred from the mother may be from the placenta or birth canal during birth. Late onset sepsis is caused by bacteria from the caregiving environment. According to WikiPedia:

Neonatal sepsis is divided into two categories: Early Onset Sepsis (EOS) and Late Onset Sepsis (LOS). EOS refers to sepsis presenting in the first 7 days of life (although some refer to EOS as within the first 72 hours of life), with LOS referring to presentation of sepsis after 7 days (or 72 hours, depending on the system used).

1. Early onset neonatal sepsis (EONS):

Onset: Birth-1 week
Usually from maternal genital tract.
Agents: GBS, E coli, Listeria
Usually present with respiratory distress

2. Late onset neonatal sepsis (LONS):

Onset: 8-28 days
Usually nosocomial or community acquired
Agents: GBS, HBV, E coli, Staphylococcus, candida
Present with meningitis

Organisms Responsible for Neonatal Sepsis:

Bacteria: Group B streptococci (GBS), E coli, Listeria, Coagulase negative staphylococci, Pseudomonas.
Viruses: HSV, Enterovirus, Toxoplasmosis
Fungi: Candida
Protozoa: Plasmodium, Toxoplasmosis.

Most frequent Signs & Symptoms of Neonatal Sepsis:

Mostly Nonspecific:

Unable to suck.
Fever or Frequent changes in temperature.
Poor cry or Lethargy.
Poor perfusion.
Diarrhea
Reduced movements
A heart rate above 160 can also be an indicator of sepsis, this tachycardia can present up to 24 hours before the onset of other signs.

Respiratory distress	Tachypnea (resp. rate. 60/min), grunting, cyanosis, retractions, nasal flaring.
Temperature instability	Fever .37.9⁰C, or hypothermia
Poor feeding	Vomiting, diarrhoea, abdominal distension.
Altered neurological status	Lethargy, irritability, hypotonia, seizures, abnormal reflex.
Apnea	especially in preterm infants
Poor perfusion	pallor, mottling, capillary refill >3 sec
Hypotension	Tachycardia
Bleeding	Purpura, Petechiae, bleeding from pric site.
Bulging fontanel	meningitis
Others	Jaundicehepatosplenomegalysclerema Painful bone & joints.

Risk factors for Neonatal Sepsis:

Major risk factors:

Premature Rupture of membrane (PROM) > 24 hrs
Maternal intrapertum fever > 100.4⁰F/ 38⁰C
Chorioamnionitis
Sustain fetal heart rate >160

Minor risk factors:

PROM >12 hrs.
Maternal intrapertum fever > 99.5⁰F/37.5⁰C
Maternal WBC count >15000/mm³
Low Apgar score (<5 at 1 minute, <7 at 5 minute)
Low birth weight (<1500g)
Preterm labour (37 weeks)
Multiple gestation
Foul lochia
Maternal GBS colonization.

Diagnosis by Investigations:

There are some investigations required to confirm the diagnosis and assist in treatment plan. The following investigations plan can be helpful in a typical case. your doctor will ask about the infant’s symptoms and medical history.

1. Blood Tests such as

DLC (Differential Leukocyte Count)
Micro ESR (Erythrocyte Sedimentation Rate) titer > 55mm
Total Leucocyte count <5000 per cubic mm.
Elevated Haptoglobulin.
Complete blood count (CBC)
Blood culture.

2. CSF Study.

3. Chest Xray.

4. Urine Culture.

5. Gastric aspirate showing > 5 polymorphs per high power field.

Treatment of Neonatal Sepsis:

Urgent treatment is necessary to save the neonate. but it is mostly clinically difficult to diagnose Sepsis. So, if there is even a remote suspicion of sepsis, they are frequently treated with antibiotics empirically. Initial Fluid resuscitation and Supportive care must be done simultaneously. Infant should be hospitalized ASAP. Treatment may last 2-21 days. Sepsis that is confirmed with a culture test is treated for 7-21 days.

Antibiotic regimen in infants with suspected sepsis is a beta-lactam antibiotic (usually ampicillin) in combination with an aminoglycoside (usually gentamicin) or a third-generation cephalosporin (usually cefotaxime). Ceftriaxone is generally avoided in neonates due to the theoretical risk of kernicterus.

Prevention of Neonatal Sepsis:

1. Mother should be under proper antenatal care. If there is any sign of premature leakage then treat with proper antibiotic (broad spectrum).

2. Baby should be born through an aseptic way. After birth, put the baby on a warm sterile cloth on a tray.

3. Keep the baby warm & clean.

4. Less handling of the baby.

5. Hand washing before handling the baby.

6. Early diagnosis of the infections by using different screening method.

7. If mother infected by any infectious disease it should be treated properly. Early treatment of infection with ampicillin, Cloxacillin, or penicillin- gentamycin.

8. After birth, the cord should be cut by a sterile blade & cleaned daily with rectified sprit until it drops it.

9. care of the eye to prevent conjunctivitis. Before the baby to open the eyelids, eye should be cleaned with sterile wet swabs. Silver nitrate solution (1%) or freshly prepared penicillin drops should be installed into eyes.

10. Baby may acquired infection from birth canal of mother so treat of mother of any infection of birth canal.