Neonatal Sepsis

Neonatal Sepsis: Basics - Tiny Patient, Big Threat

Neonatal sepsis: systemic infection in first 28 days of life. High mortality/morbidity.

• Classification based on age of onset:
  • Early Onset Sepsis (EOS): onset <72 hours of life.
  • Late Onset Sepsis (LOS): onset ≥72 hours of life.
• EOS vs. LOS:

Neonatal Sepsis: Culprits & Causes - The Usual Suspects

-   Prolonged Rupture of Membranes (PROM > **18** hrs)
-   Maternal intrapartum fever (≥ **38**°C)
-   Chorioamnionitis
-   Maternal GBS colonization

• Neonatal Risk Factors:
  • Prematurity (< 37 weeks gestation)
  • Low Birth Weight (LBW < 2500g)
  • Invasive procedures (e.g., central lines)
  • Asphyxia

⭐ Group B Streptococcus (GBS) is the most common cause of Early Onset Sepsis in many regions.

Neonatal Sepsis: Spotting Trouble - Subtle Signs

Early recognition is key. Watch for these often non-specific signs:

• 📌 SUBTLE signs:
  • Skin: Pallor, mottling, cool peripheries, ↑CRT >3s.
  • Unusual: Lethargy, irritability, high-pitched cry, hypotonia.
  • Breathing: Mild tachypnea, grunting, nasal flaring.
  • Temperature: Instability (fever >38°C or hypothermia <36.5°C).
  • Low Intake: Poor suck, vomiting, feeding intolerance.
  • Early/Persistent Jaundice; Enlarged Abdomen (distension).

⭐ Temperature instability (fever or hypothermia) is a common but non-specific sign of neonatal sepsis.

Neonatal Sepsis: Detective Work - Finding Clues

• Key Investigations:

  • Blood Culture: Gold standard.
  • Complete Blood Count (CBC): TLC <5000/mm³, ANC <1800/mm³, I/T ratio >0.2.
  • C-Reactive Protein (CRP): >10 mg/L (serial values more informative).
  • Lumbar Puncture (LP): If meningitis suspected or blood culture positive.
  • Consider: Urine culture (late onset), CXR (respiratory signs).

• Sepsis Screen Interpretation: ≥2 positive markers highly suggestive.

  Component	Positive Threshold
  TLC	<5000/mm³
  I/T Ratio	>0.2
  CRP	>10 mg/L
  Micro-ESR	>15 mm/1st hr

⭐ Blood culture is the gold standard for diagnosing neonatal sepsis.

Neonatal Sepsis: Battle Plan - Fighting Back

⭐ Empirical antibiotic therapy for EOS typically includes Ampicillin and an Aminoglycoside (e.g., Gentamicin).

Empirical Antibiotics (IV):

Supportive Care:

• Maintain: Thermoregulation, Glucose, Perfusion
• Support: Respiratory (O2, CPAP, MV), Cardiovascular (Fluids, Inotropes)
• Nutrition: Early enteral/parenteral

Prevention:

• Antenatal: GBS screen, Intrapartum Antibiotic Prophylaxis (IAP)
• Postnatal: Hand hygiene, Aseptic techniques, Breastfeeding

Treatment Algorithm:

High‑Yield Points - ⚡ Biggest Takeaways

• Early Onset Sepsis (EOS) occurs < 72 hours; Late Onset Sepsis (LOS) > 72 hours.
• Common EOS pathogens: Group B Streptococcus (GBS), E. coli. LOS: CoNS, Klebsiella, Candida.
• Key risk factors: Prematurity, Prolonged Rupture of Membranes (>18h), maternal chorioamnionitis.
• Clinical signs are often non-specific: lethargy, poor feeding, temperature instability, respiratory distress.
• Blood culture is the gold standard for diagnosis; sepsis screen (CRP, TLC) aids suspicion.
• Empirical antibiotics for EOS: Ampicillin plus an aminoglycoside (e.g., Gentamicin).