Definition

Neonatal sepsis is a bacterial infection in the blood. It is found in infants during the first month of life. This may become a serious condition. If you suspect your infant has this condition, contact your baby’s doctor right away.

Early-onset sepsis develops in the first 2-3 days after birth. Late-onset sepsis develops within 3-7 days after birth.

Causes

Neonatal sepsis is caused by bacteria. The infant may come in contact with bacteria during pregnancy, birth, or from the environment after birth.

Early-onset sepsis is caused by an infection from the mother. It may pass to the infant from the placenta or birth canal during birth. Antibiotics may be given to high risk mothers during labor. This may prevent early-onset bacterial sepsis in some infants.

Late-onset sepsis is caused by bacteria from the healthcare environment.

Risk Factors

Infant boys have a higher risk for neonatal sepsis. Other factors that may increase your infant’s chance of neonatal sepsis include:

• Premature birth—more than 3 weeks before due date
• Early labor—more than 3 weeks before your due date
• Fetal distress before birth
• Infant has a very low birth weight
• Fetus has a bowel movement before birth and fetal stool is in the uterus
• Amniotic fluid surrounding the infant has a bad smell or the infant has a bad smell right after being born

Pregnancy conditions or mother’s health issues that increase your infant’s chance of neonatal sepsis include:

• Labor complications resulting in traumatic or premature delivery
• Water that broke more than 18 hours before giving birth
• Fever or other infections during labor
• Need for a catheter for a long time while you are pregnant
• Presence of group B streptococcal bacteria in vaginal or rectal areas
• Many courses of prenatal steroids
• Prolonged internal monitoring during labor and delivery

Symptoms

In most cases of early-onset sepsis, symptoms are present within 24 hours of birth. In almost all cases, symptoms will be present within 48 hours of birth. If your infant has any one of these symptoms, especially in first week, contact your doctor.

• Fever or frequent changes in temperature
• Breathing rapidly, difficulty breathing, or periods of no breathing (apnea)
• Poor feeding from breast or bottle
• Decreased or absent urination
• Bloated abdomen
• Vomiting yellowish material
• Diarrhea
• Extreme redness around the belly button
• Skin rashes
• Difficulty waking your infant or unusual sleepiness
• Yellowed or overly pale skin
• Abnormally slow or fast heartbeat
• Bruising or bleeding
• Cool, clammy skin

It is important for your doctor to evaluate any fever in your infant.

Diagnosis

You will be asked about your infant’s symptoms and medical history. A physical exam will be done.

Your baby’s bodily fluids and tissues may be tested. This can be done with:

• Blood tests
• Blood and urine cultures
• Lumbar puncture —to evaluate cerebrospinal fluid that protects the brain and spinal cord
• Samples of skin lesions

Images may be taken of your baby’s chest and/or abdomen. This can be done with x-rays.

Treatment

Talk with your doctor about the best treatment plan for your infant. Treatment depends on how severe the condition is. If sepsis is suspected, your infant will be hospitalized while you wait for test results.

Treatment may last 2-21 days. Mild symptoms may be monitored without antibiotics. Your infant will be sent home when tests show there are no bacteria. Sepsis that is confirmed with a culture test is treated for 7-21 days. Treatment will depend on the location of the infection and may include:

Prevention

To reduce your infant’s chance of getting neonatal sepsis, your doctor may take the following steps:

• Antibiotics can control dangerous bacteria in the mother. It will prevent the spread of bacteria during pregnancy or birth to the infant. Your doctor may recommend antibiotics if:
  • The birth mother has previously given birth to an infant with neonatal sepsis.
  • You have had a positive bacterial infection test before your due date.
• Breastfeeding may also help prevent sepsis in some infants.
• Follow steps to prevent premature labor or birth. This can include proper prenatal care, avoiding drugs and alcohol, and eating a healthy balanced diet.

Centers for Disease Control and Prevention http://www.cdc.gov

Sick Kids—The Hospital for Sick Children http://www.sickkids.ca

Late-onset neonatal sepsis. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated June 26, 2015. Accessed September 15, 2015.

Neonatal sepsis (sepsis neonatorum). The Merck Manual Professional Edition website. Available at:
http://www.merckmanuals.com/professional/pediatrics/infections_in_neonates/neonatal_sepsis.html
Updated May 2013. Accessed September 15, 2015.