A systemic illness caused by bacteremia in first month of life

Types Of Sepsis

Early Onset Sepsis (EOS)

EOS is defined as culture proven infection in newborn at <7 days of age.

Pathophysiology

Newborn has acquired the organism during the antepartum or intrapartum period from the maternal genital tract.

Risk Factors

• Prematurity
• Low Birth Weight
• Maternal peripartum infection
• Rupture of membranes > 18 hours
• Fetal distress
• Multiple gestation

Most common microorganisms are

• Group B Streptococcus
• Haemophilus influenzae
• Streptococcus pneumoniae
• Listeria monocytogenes
• S aureus
• Enterococci
• Other gram-negative bacteria (Klebsiella, Citrobacter, Serratia, and Enterobacter)

Clinical Presentation

Clinical signs and symptoms of sepsis are nonspecific

• Temperature Instability
• Lethargy, Irritability
• Poor peripheral perfusion, cyanosis, Mottling
• Tachypnea ,tachycardia, Hypotension
• Seizures, Change in tone
• Metabolic; Metabolic findings include hyperkalemia, hyponatremia, hyperglycemia, or metabolic acidosis

Diagnosis

• Full Blood Count
• C reactive Protein (Synthesis of CPR by hepatocytes is modulated by cytokines. Interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor (TNF) are the most important regulators of CRP synthesis). CRP secretion starts within 4 to 6 hours after the inflammatory stimulus and peaks at approximately 36 to 48 hours. The biologic half-life of CRP is 19 hours, with a 50% reduction daily after the acute phase stimulus resolves.
• Procalcitonin (Released by parenchymal cells in response to bacterial toxins)
• Chest Radiograph; should be obtained in cases with respiratory symptoms
• Blood culture and sensitivity (Blood C/S); The minimum volume for blood culture is 1 mL
• Neutrophil surface antigens CD11, CD14, and CD64 are promising markers of early infection- Presepsin (soluble CD14 subtype) sepsis marker
• Examination of the placenta and fetal membranes- Evidence of chorioamnionitis

Management

Prevention

Approximately 20% to 30% of pregnant women are colonized with GBS in the vaginal or rectal area. Guidelines recommend that all pregnant women should be screened at 36 0/7 to 37 6/7 weeks’ gestation for vaginal and rectal GBS colonization. At the time of labor or rupture of membranes, Intrapartum Antibiotic Prophylaxis (IAP) should be given to all pregnant women identified as GBS carriers. Penicillin is the drug of choice, but ampicillin is an acceptable alternative. First generation cephalosporins (ie, cefazolin) are recommended for women whose reported penicillin allergy.

Treatment

• Empiric antibiotic therapy; Treatment for EOS is often begun before a definite causative agent is identified. It usually consists of ampicillin and gentamicin.
• Continuing therapy is based on culture and sensitivity results and clinical course

Late Onset Sepsis (LOS)

LOS is defined as culture proven infection in newborn at >7days of age.

Pathophysiology

LOS acquired after birth from the maternal genital tract (vertical transmission) as well as organisms acquired after birth from human contact or from contaminated equipment/environment (nosocomial). Therefore, horizontal transmission appears to play a significant role in LOS.

Microorganisms

• Coagulase-negative staphylococci (CONS), especially Staphylococcus epidermidis
• S aureus
• Group B Streptococcus (GBS)
• Gram-negative rods (including Pseudomonas, Klebsiella, Serratia, E coli, and Proteus)
• Fungal Microorganisms

Risk Factors

• Prematurity
• Low Birth Weight
• Invasive Procedures – IV cannulation, ETT, NG Tube, Umbilical Catheter and PICC Line
• Use of Antibiotics
• Prolonged mechanical ventilation
• Prolonged hospitalization
• Bottle Feeding

Conclusion

With early diagnosis and treatment, most infants will recover and not have
long-term complications. However, the mortality rate is still significant.