Neonatal sepsis

In the Neonatal sepsis it is a bacterial infection in the newborn child, which occurs in 0.1 to 0.8 percent of all newborns. This occurs above all when the immune system is not yet fully developed, as in premature babies. A distinction is made between early and late sepsis depending on the time of infection.

What is newborn sepsis?

Depending on the type of sepsis, the symptoms appear either on the first day of life or after the first week of life.
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If the newborn is infected before or during birth, it is Early sepsis. The leading pathogens that are transmitted from mother to newborn are beta-hemolytic streptococci and Escherichia coli. These get into the vagina via the rectum, inflame the membranes and can easily get into the amniotic fluid.

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Alternatively, they are taken in by the child immediately during the birth process. The bacteria spread in the blood and cause excessive foci of infection that can lead to septic shock. In late sepsis, the first symptoms can only be recognized after the first week of life. The infection with the pathogen occurred either vertically during the birth process or through direct contact with the germs.

In particular, if invasive methods such as the use of forceps are used during childbirth, the baby's skin can be injured and thus allow the germs direct access. In contrast to early sepsis, the immune system can suppress the infection for a while.

causes

The cause of newborn sepsis is an insufficiently developed immune system in the child. This is often the case when the child is born before the 37th week of pregnancy. There is a direct correlation between low birth weight and the risk of neonatal sepsis. Infection of the mother with beta-hemolytic streptococci or other pathogens is a prerequisite for early sepsis, which can occur in the womb.

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The presence of an amniotic infection syndrome, in which the amniotic sac and the membranes are infected, also leads to newborn sepsis. An increased risk of blood poisoning in the newborn entails an early rupture of the bladder, which clears the way for all bacteria to enter the uterus.

Symptoms, ailments & signs

Depending on the type of sepsis, the symptoms appear either on the first day of life or after the first week of life. The transition from a healthy-looking child to a seriously ill state is usually sudden, with septic shock, which can lead to death, already set in after a few hours. Depending on the point at which the initial infection occurred, the first changes can be determined there.

These signs of infection can appear on the respiratory organs, on the skin or in the digestive system. From the outside, the infection first makes itself visible in diffuse symptoms, such as poor drinking, an increased temperature and sensitivity to touch in the child. If the infection occurred in the respiratory system, it can lead to respiratory distress syndrome or breathing pauses can be detected.

The signs of infection on the skin are expressed in edema, pus vesicles, inflammation of the umbilical cord or yellowing of the eyes. If the nervous system is affected, apathy, impaired consciousness, drowsiness, convulsions, or bulging fontanels are warning signs of neonatal sepsis.

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In late sepsis, children are often affected by meningitis. An infection of the digestive tract is associated with refusal to eat, diarrhea or constipation and enlargement of the liver and spleen.

Diagnosis & course of disease

The first diagnostic measure to clarify the pathogens is a blood sample, from which a blood culture is created. If the finding shows a lack of leukocytes - leukopenia, this is usually considered a sure sign of sepsis. In late sepsis, urine cultures are created, and if meningitis is present, the bacteria causing the infection are determined using a lumbar puncture.

With timely treatment with antibiotics, neonatal sepsis can be cured quickly. Sometimes pulmonary hypertension or nervous system damage is left behind. However, if the first warning signs are overlooked, the infection can cause septic shock in the newborn that leads to death within a few hours. Delayed treatment occurs in 10 to 25 percent of cases.

Complications

As a potentially life-threatening infection, neonatal sepsis can lead to numerous complications. With a symmetrical, i.e. very even distribution of toxins or bacteria in the bloodstream, there is definitely a risk of death without immediate treatment. Affected babies must be monitored urgently in the intensive care unit because they do not have a sufficiently developed immune system.

Breaking down toxic substances or successfully combating bacteria is therefore primarily the responsibility of the doctor. According to the usual initial symptoms, the newborn can develop unspecific and difficult to assess complications. Over time, blood poisoning affects more and more organs. An increased heartbeat and shortness of breath usually occur quickly. A deposit of the microorganisms in the ear can lead to a severe otitis media with occlusion of the ear canal.

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A possible meningitis (meningitis) is a particularly high hazard potential. A swollen fontanel and very high frequency screaming are hallmarks of this complication. Pneumonia can also develop as a consequence of sepsis. Babies typically drink little fluids during sepsis and are at risk of dehydration as a result. Long-term damage or the death of the offspring due to septic shock with multiple organ failure if therapy is started too late cannot be ruled out.

Permanent neurological malfunctions and high blood pressure in the pulmonary vessels occur depending on the severity and severity of the course. If the disease is recognized in good time, there is still a risk that intolerance may arise due to antibiotic treatments. The death rate under these conditions is around four percent.

When should you go to the doctor?

If the birth of a child takes place in an inpatient setting or in a birthing center, mother and child are always accompanied by obstetricians during the delivery. In most cases, the support takes place a few hours or days after the birth.

If during this time there are irregularities in the health of the newborn, the nurses, midwives or doctors take over the examinations of the baby. If they notice abnormalities or peculiarities of the state of health, the newborn is automatically given medical care. In these cases, the parents or relatives do not have to take action.

If neonatal sepsis develops after discharge from hospital or after working with obstetricians, a doctor's visit is necessary. Refusal of food, fever or behavioral problems must be assessed and clarified by a doctor. If there is an apathetic appearance or indifference, there is cause for concern.

An increased need for sleep, rapid fatigue and a lack of response to social interactions should be discussed with a doctor. Changes in the appearance of the skin, cramps or a breathing disorder must be examined by a doctor. Since neonatal sepsis can lead to premature death without medical treatment, a visit to a doctor is advisable as soon as the first irregularities occur.

Treatment & Therapy

The treatment of neonatal sepsis is done with antibiotics that are administered via an infusion. In the beginning, broad-spectrum antibiotics are used, which are used while the results of the blood and urine cultures are still pending. In early sepsis, aminopenicillin or a combination of cephalosphorin / aminopenicellin is given.

In addition to treating the infection, additional measures are taken to stabilize the condition of the newborn. In addition to giving fluids via an infusion, ventilation may be necessary. Possible hypoglycaemia or anemia are also treated.

Outlook & forecast

In principle, neonatal sepsis must always be treated in intensive care. Since it is a highly acute clinical picture, it represents an emergency. The prognosis therefore depends on how quickly the therapy is initiated. Consequential damage can only be avoided with the fastest possible treatment.

The prognosis depends on the duration of the newborn infection. The longer this has existed, the more organs are attacked by it and the higher the risk of it spreading to the brain. In the worst case, neonatal sepsis can trigger septic shock that ends in circulatory failure. The result would be kidney and lung failure, in the worst case multiple organ failure occurs.Without therapy, neonatal sepsis can be fatal within a few hours to days.

It is crucial for the prognosis that therapy is started as early as possible. Good prophylaxis and rapid antibiotic treatment help ensure that only about four percent of children die of newborn sepsis. Therapy should begin as soon as there is a mere suspicion; the antibiotics can then be adjusted once the pathogen is detected.

If the newborn recovers from the disease, long-term consequences are usually not to be expected. However, if meningitis occurs as part of the neonatal sepsis, the result may be delayed development, cerebral palsy or even hearing loss.

prevention

In many countries, between the 35th and 37th week of pregnancy, a smear is taken from the mother's vagina and rectum. This is examined for beta-hemolytic streptococci of group B, which are primarily responsible for early sepsis.

If the result is positive, the mother is given an infusion of antibiotics such as penicillin G or ampicillin immediately before natural birth. This measure significantly reduces the risk of infection. In order to avoid late sepsis, elementary hygiene measures, such as hand washing, are essential when dealing with children.

Aftercare

In most cases of neonatal sepsis, the patient has only very limited direct follow-up measures available. Even in the worst case scenario, the child can die if the newborn sepsis is recognized and treated late. Therefore, parents in particular should pay particular attention to the symptoms and complaints of this disease and immediately consult a doctor and initiate treatment so that no further complications and complaints can occur.

Newborn sepsis is usually alleviated and completely restricted by taking various medications and antibiotics. Attention should be paid to the correct dosage and regular intake in order to prevent further complications and complaints. If anything is unclear or if you have any questions, a doctor should be consulted first.

In many cases, parents have to rely on the help and support of their own families when they have newborn sepsis. Above all, this can prevent and alleviate psychological upsets or depression. If neonatal sepsis is recognized and treated early, there is generally no reduction in life expectancy for the person affected.

You can do that yourself

Self-help measures are not indicated in case of neonatal sepsis. There are no ways that can alleviate the symptoms without medical care. Since the child's life is in danger, intensive medical care is necessary. By their very nature, newborns cannot change their situation. Parents and relatives also find themselves helpless in the face of developments in the infant's acute health condition.

The actions of the doctors can be trusted during this time. Parents should obtain comprehensive information about the condition of their offspring and ask the care team all open questions. In addition, it is possible to read about the disease in specialist literature, which developments can be expected and which room for maneuver is available. Internal disagreements and disputes must be avoided in this situation.

In the case of decision-making issues, it should be possible to act in the interests of the newborn as quickly as possible, and this succeeds if all those affected treat each other in harmony. Delays or the need to contact the authorities can have devastating effects on the health of the child, as treatment measures often have to be initiated quickly and require parental consent. For a mental strengthening, the relatives should support each other or seek professional help.