Neonatal sepsis

Question 1

What is neonatal sepsis?

Answer 1

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.

Question 2

Organisms that cause neonatal sepsis?

Answer 2

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.

Question 3

Risk factors for neonatal sepsis?

Answer 3

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)

Question 4

Clinical features neonatal sepsis?

Answer 4

Fever
Reduced tone and activity
Poor feeding
Respiratory distress or apnoea
Vomiting
Tachycardia or bradycardia
Hypoxia
Jaundice within 24 hours
Seizures
Hypoglycaemia

Question 5

Red flags for neonatal sepsis?

Answer 5

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

Question 6

Management of presumed neonatal sepsis?

Answer 6

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.