Neonatal sepsis

INTRODUCTION

• Neonatal sepsis is a life-threatening infection in newborns (0–28 days) caused by bacteria, viruses, or fungi. It is a major cause of neonatal morbidity and mortality, especially in developing countries.

  
  

DEFINITION

• Neonatal sepsis is defined as

• A systemic infection occurring in infants within the first 28 days of life, confirmed by clinical signs and/or positive blood culture.

  
  

TYPES

Early-Onset Sepsis (EOS)

• Occurs within first 72 hours of life

• Usually from maternal infection

Late-Onset Sepsis (LOS)

• Occurs after 72 hours to 28 days

• Usually from hospital or community exposure

CAUSES

Common Organisms

Bacteria

• Group B Streptococcus (GBS)

• E. coli

• Klebsiella

• Staphylococcus aureus

Viruses

• Herpes simplex virus (HSV)

Fungi

• Candida

RISK FACTORS

Maternal Factors

• Prolonged rupture of membranes (>18 hours)

• Maternal fever during labor

• Urinary tract infection

• Chorioamnionitis

• Poor antenatal care

Neonatal Factors

• Low birth weight (<2.5 kg)

• Prematurity

• Birth asphyxia

• Meconium aspiration

• Invasive procedures (IV lines, ventilation)

CLINICAL MANIFESTATIONS

DIAGNOSIS

• Laboratory Tests

• Blood culture (gold standard)

• Complete blood count (CBC)

• ↓ WBC or ↑ WBC

• C-reactive protein (CRP)

• Procalcitonin

Other Investigations

• Lumbar puncture (for meningitis)

• Chest X-ray (if respiratory symptoms)

• Urine culture

Management

1. Supportive Care

• Maintain temperature (warmth)

• Oxygen therapy

• IV fluids

• Maintain blood glucose

• Monitor vital signs

2. Antibiotic Therapy

• (Start immediately—don’t wait for culture)

• Empirical Treatment

• Ampicillin + Gentamicin (most common)

• If severe or resistant

• Cefotaxime / Vancomycin (as per hospital protocol)

3. Specific Treatment

• Antifungal (for Candida)

• Antiviral (Acyclovir for HSV)

4. Nursing Management

• Hand hygiene (infection control)

• Monitor vital signs frequently

• Maintain feeding (breastfeeding if possible)

• Strict aseptic technique

• Educate parents

  
  

COMPLICATIONS

• Septic shock

• Meningitis

• Pneumonia

• Disseminated intravascular coagulation (DIC)

• Death

  
  

PREVENTION

• Proper antenatal care

• Clean delivery practices

• Early breastfeeding

• Infection control in NICU

• Screening for maternal infections

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🚀Here’s a short “exam trick” version for Neonatal Sepsis — super quick points you can remember :

🧸 Introduction

👉 Life-threatening infection in newborn (0–28 days)

📖 Definition

👉 Systemic infection with clinical signs ± positive blood culture.

🦠 Types

👉 Early-onset (≤72 hrs) – maternal origin

👉 Late-onset (>72 hrs) – hospital/community origin

⚡ Causes

👉 Bacteria (GBS, E. coli), virus (HSV), fungi (Candida)

⚠️ Risk Factors

👉 Maternal infection + PROM + prematurity + low birth weight

🧠 Clinical Manifestations

👉 Poor feeding, lethargy, temp instability, apnea, seizures

🔍 Diagnosis

👉 Blood culture (gold standard) + CBC + CRP

💊 Management

👉 Early antibiotics (Ampicillin + Gentamicin) + supportive care

👩‍⚕️ Nursing Care

👉 Maintain warmth, hygiene, monitor vitals, support feeding

🚨 Complications

👉 Shock, meningitis, DIC, death

🛡️ Prevention

👉 Clean delivery + antenatal care + infection control

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🚀Here’s a set of 07 MCQs on Neonatal Sepsis for practice :

1. Neonatal sepsis is defined as:

A. Local infection in newborn

B. Systemic infection in newborn up to 28 days

C. Infection after 1 month

D. Only bacterial infection

✅ Answer: B

2. Early-onset neonatal sepsis occurs within:

A. 24 hours

B. 48 hours

C. 72 hours

D. 7 days

✅ Answer: C

3. Most common cause of early-onset neonatal sepsis:

A. Staphylococcus aureus

B. Group B Streptococcus

C. Candida

D. HSV

✅ Answer: B

4. Which is a major risk factor for neonatal sepsis?

A. High birth weight

B. Prolonged rupture of membranes

C. Normal delivery

D. Breastfeeding

✅ Answer: B

5. Gold standard investigation for neonatal sepsis:

A. CBC

B. CRP

C. Blood culture

D. X-ray

✅ Answer: C

6. First-line empirical treatment:

A. Paracetamol

B. Ampicillin + Gentamicin

C. Acyclovir

D. Antifungal

✅ Answer: B

7. Common clinical sign of neonatal sepsis:

A. Hyperactivity

B. Poor feeding

C. Weight gain

D. Increased sleep only

✅ Answer: B