Neonatal sepsis is caused by infection in the neonatal period. It potentially results in significant morbidity and mortality for the affected infant, particularly if treatment is delayed. It presents with non-specific signs and requires a high degree of suspicion and a low threshold for starting treatment with broad spectrum antibiotics. This is a brief summary to help your learning, always refer to local and national guidelines and involve seniors when treating patients.
Common Organisms
- Group B streptococcus (GBS)
- Escherichia coli (e. coli)
- Listeria
- Klebsiella
- Staphylococcus aureus
TOM TIP: The organism to remember for your exams is group B strep (GBS). This is a common bacteria found in the vagina. It does not cause any problems for the mother, but can be transferred to the baby during labour and cause neonatal sepsis. Prophylactic antibiotics during labour are used to reduce the risk of transfer if the mother is found to have GBS in their vagina during pregnancy.
Risk Factors
- Vaginal GBS colonisation
- GBS sepsis in a previous baby
- Maternal sepsis, chorioamnionitis or fever > 38ºC
- Prematurity (less than 37 weeks)
- Early (premature) rupture of membrane
- Prolonged rupture of membranes (PROM)
Clinical Features of Neonatal Sepsis
- Fever
- Reduced tone and activity
- Poor feeding
- Respiratory distress or apnoea
- Vomiting
- Tachycardia or bradycardia
- Hypoxia
- Jaundice within 24 hours
- Seizures
- Hypoglycaemia
Red Flags
- Confirmed or suspected sepsis in the mother
- Signs of shock
- Seizures
- Term baby needing mechanical ventilation
- Respiratory distress starting more than 4 hours after birth
- Presumed sepsis in another baby in a multiple pregnancy
Treating For Presumed Sepsis
Always check your local policy and consult with experienced paediatricians when treating neonates that potentially have sepsis. Most local policies will follow something similar to the NICE guidelines:
- If there is one risk factor or clinical feature, monitor the observations and clinical condition for at least 12 hours
- If there are two or more risk factors or clinical feature of neonatal sepsis start antibiotics
- Antibiotics should be started if there is a single red flag
- Antibiotics should be given within 1 hour of making the decision to start them
- Blood cultures should be taken before antibiotics are given
- Check a baseline FBC and CRP
- Perform a lumbar puncture if infection is strongly suspected or there are features of meningitis (e.g. seizures)
Antibiotic Choice
Always check your local antibiotic policy. The NICE guidelines (2012) recommend benzylpenicillin and gentamycin as first line antibiotics.
Alternatively a third generation cephalosporin (e.g. cefotaxime) may be given as an alternative in lower risk babies.
Ongoing Management
Check the CRP again at 24 hours and check the blood culture results at 36 hours:
Consider stopping the antibiotics if the baby is clinically well, the blood cultures are negative 36 hours after taking them and both CRP results are less than 10.
Check the CRP again at 5 days if they are still on treatment:
Consider stopping antibiotics if the baby is clinically well, the lumbar puncture and blood cultures are negative and the CRP has returned to normal at 5 days.
Consider performing a lumbar puncture if any of the CRP results are more than 10.
Last updated January 2020