Neonatal sepsis

Abstract

Neonatal sepsis (NS) refers to a group of physical and laboratory findings occuring as a response to invasive infection in neonates. In early-onset sepsis (EOS) symptoms occur within the first 7 days, while in late-onset sepsis (LOS) between the 7th and 30th day of life. NS is a major cause of newborn morbidity and mortality. Improvements in intensive care have decreased the impact of EOS in term infants, with a reported incidence of approximately 1 – 2 cases per 1000 live births. Preterm infants are more prone to both EOS and LOS. Despite intrapartum prophylaxis against Streptococcus agalactiae (group B streptococcus, GBS), GBS remains the leading cause of EOS in term infants. In preterm infants the most common etiologic agents are gram negative rods (Escherichia coli, Klebsiella species, other Enterobacteriaceae) and Pseudomonas. Staphylococci and Enterococci more commonly cause LOS. Signs and symptoms of NS are nonspecific. A significant number of patients have meningitis. A definitive diagnosis is based on positive blood culture. Laboratory tests such as White Blood cell Count, C Reactive Protein or Procalcitonin can be helpful in establishing the diagnosis. Treatment should be directed towards maintaining adequate organ perfusion. The choice of antibiotics is influenced by the timing of NS occurrence. EOS should be treated with ampicillin plus gentamicin, or ampicillin plus cefotaxime. In neonates with community-acquired LOS empiric therapy includes cefotaxime or ceftriaxone plus ampicillin. For hospital-acquired LOS, the choice of antimicrobials should be based on the prevailing nosocomial flora. The overall fatality rate in NS ranges from 5 to 10% and survivors remain at high risk (20%) for neurologic sequelae and lifelong impairments.