Diseases & Conditions


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Sepsis


Sepsis is bacterial infection in the blood.

Newborns, especially premature ones, are at much higher risk of sepsis than are children and adults because of their immature immune system. Premature newborns also lack certain antibodies against specific bacteria; these antibodies usually cross the placenta from the mother late in pregnancy. Another important risk factor for sepsis is the use of intravenous lines and ventilators.

The most common type of bacteria causing sepsis in the newborn around the time of birth is Group B streptococcus. Sepsis that occurs later while the newborn is being cared for in the neonatal intensive care unit (NICU) is most likely to be caused by a type of staphylococcus (coagulase negative).

Some Infections of Newborns

Infection

Mode of Infection

Symptoms

Treatment/Prevention

Herpes

Herpes Simplex in a Newborn

Usually, the virus (herpes simplex) infects the fetus after rupture of the membranes during labor and delivery Usually, a skin rash of small fluidfilled blisters appears; infection may be widespread, affecting many organs, such as eyes, lungs, liver, brain, and skin Antiviral drugs are given intravenously; eye infections are treated with trifluridine drops

Hepatitis B

Usually, the virus infects the fetus after rupture of the membranes during labor and delivery Chronic liver infection (chronic hepatitis) develops but usually does not produce symptoms until young adulthood A newborn born to an infected mother is given both hepatitis B virus vaccine and hepatitis B immune globulin within 24 hours of birth.

Cytomegalovirus infection

The virus is thought to cross the placenta from the mother during pregnancy or during delivery (a risk of 1%); after birth, a newborn may become infected from infected breast milk or contaminated blood from a transfusion Most newborns do not have symptoms; about 10% have low birth weight, a small head, jaundice, small bruises, and an enlarged liver and spleen; deafness may occur The infection cannot be cured; ganciclovir may help some symptoms; newborns should have repeated hearing evaluations during the first year

Rubella

The virus may cross the placenta during pregnancy (rare because vaccination is now routine); infection is more severe if the fetus is infected early in pregnancy Effects on the fetus range from death before birth to birth defects or hearing loss without other symptoms; newborns may have low birth weight, brain inflammation, cataracts, damage to retina, heart defects, an enlarged liver and spleen; bruising, bluish red skin lesions, enlarged lymph nodes, and pneumonia No specific treatment is available; to prevent infection in the mother, all women of childbearing age should be vaccinated before pregnancy; immune globulin is sometimes injected if a pregnant woman who has not been immunized comes into close contact with an infected person early in pregnancy

Toxoplasmosis

The parasite ( Toxoplasma gondii ) may cross the placenta during pregnancy; infection is more severe if the fetus is infected early in pregnancy The fetus may grow slowly and be born prematurely; the newborn may have a small head, brain inflammation, jaundice, an enlarged liver and spleen, and inflammation of the heart, lungs, or eyes; rashes may occur Women should avoid handling cat litter during pregnancy; transmission from the mother to the fetus may be prevented if the mother takes spiramycin; pyrimethamine and sulfonamides may be taken later in pregnancy if the fetus is infected; infected newborns with symptoms are treated with pyrimethamine, sulfadiazine, and leucovorin; corticosteroids can be used for inflammation of heart, lungs, or eyes

Syphilis

The bacterium ( Treponema pallidum ) crosses the placenta during pregnancy if the mother acquires syphilis during pregnancy or if she has been inadequately treated for syphilis in the past Stillbirth or premature birth may occur. The newborn may have no symptoms; in the first month of life, the newborn may develop large fluid-filled blisters or flat copper-colored rash on palms and soles, with raised bumps around the nose and mouth and in the diaper area; usually lymph nodes, liver, and spleen are enlarged; the newborn may not grow well and have a characteristic "old man" look, with cracks around the mouth; mucus, pus, or blood may run from the nose; rarely, meningitis occurs Before birth, the mother is treated with penicillin. After birth, if still infected, the mother and newborn are treated with penicillin

Conjunctivitis

Conjunctivitis in a Newborn

The bacteria (most commonly Chlamydia or Neisseria gonorrhoeae ) infects the fetus after rupture of the membranes during labor or delivery When caused by Chlamydia :

Conjunctivitis usually begins 5 to 12 days after delivery but sometimes 6 weeks after, as watery discharge from eyes containing increasing amounts of pus When caused by Neisseria gonorrhoeae :

Conjunctivitis begins usually 2 to 3 days after, but sometimes up to 7 days after, delivery, as discharge of pus from eyes When caused by Chlamydia :

Erythromycin is given as eye ointment and also as tablets by mouth When caused by Neisseria gonorrhoeae :

An eye ointment containing polymyxin and bacitracin, erythromycin, or tetracycline is used. An antibiotic such as ceftriaxone is also given intravenously

Human papillomavirus infection

Usually newborns become infected during delivery Symptoms are an altered cry; sometimes difficulty breathing or even significant obstruction of the airways due to warts that grow inside the windpipe; lung infection Warts are removed surgically; recurrence can be reduced by use of interferon

Symptoms and Diagnosis

A newborn with sepsis is usually listless, does not feed well, and often has a low body temperature. Other symptoms may include pauses in breathing (apnea), fever, pale color, and poor skin circulation, with cool extremities, abdominal swelling, and jaundice.

Because newborns have decreased immunity against infection, bacteria in the bloodstream may invade and infect various organs. One of the most serious complications of sepsis is infection of the membranes surrounding the brain (meningitis). A newborn with meningitis may have extreme lethargy, coma, seizures, or bulging of the fontanelle (the soft spot between the skull bones). A doctor can rule out or diagnose meningitis by performing a spinal tap (lumbar puncture), examining the cerebrospinal fluid, and culturing a sample of this fluid. Infection of a bone (osteomyelitis) may cause pain and swelling of an arm or leg, often suspected because the newborn does not move that extremity. Infection of a joint may cause swelling, warmth, redness, and tenderness over the joint, again with little or no movement of that joint. If joint infection is suspected, a sample of fluid from the infected site is removed by needle and cultured.

Treatment and Prognosis

While awaiting blood culture results, a doctor gives intravenous antibiotics to a newborn with suspected sepsis. Once the specific organism has been identified, the type of antibiotic can be adjusted. In addition to antibiotic therapy, other treatments may be needed, such as use of a ventilator, intravenous fluids, and support of the blood pressure and circulation.

Sepsis is the major cause of mortality in premature newborns after the first week. Newborns who recover from sepsis should not have long-term problems, except those with meningitis, who may have mental delay, cerebral palsy, seizures, or hearing loss later in life.

Last full review/revision February 2003

Source: The Merck Manual Home Edition