Timely recognition and treatment of newborn infections is very important and can often avoid severe injuries or even death. New parents should be aware of the signs and symptoms of neonatal sepsis. Neonatal sepsis can often be treated with early recognition which could prevent severe injuries or even death in newborns.
What Is Neonatal Sepsis?
Neonatal sepsis is an infection of the bloodstream in newborn babies. It poses a severe health risk resulting in brain damage, internal organ damage, or even death. Some birth injuries stemming from neonatal sepsis are:
- Septic Shock (dangerously low blood pressure)
- Neonatal Seizures
- Respiratory Distress
- Meningitis (infection around the brain or spinal cord)
- Encephalitis (inflammation of the brain)
Due to the extreme danger posed by neonatal sepsis, the hospital staff is extra vigilant for risk factors of infections. Neonatal sepsis is caused by bacteria, viruses, and other pathogens and can be transmitted to babies through vertical or horizontal transmission. Horizontal transmission happens after birth through contact with caregivers, medical personnel, or environmental contaminants. Vertical transmission happens when a maternal infection spreads to the baby shortly before or during birth.
The risk of vertical transmission is greater when the mother suffers a premature rupture of the membrane, infection of the placenta or fetal membrane, Group B Strep, or high temperature during birth. There is also an increased risk if the baby is born prematurely, the doctors use forceps during birth, or the hospital uses electrodes for intrauterine monitoring during labor.
Symptoms of Neonatal Sepsis
Medical staff should also be vigilant for signs of neonatal sepsis in babies. Before birth, fetal tachycardia (an abnormally low heart rate), signs of fetal distress, and meconium-stained amniotic fluid are all signs of a heightened risk of infection. After birth, symptoms of neonatal sepsis include a low Apgar score (6 or lower), temperature control issues, respiratory issues, low blood pressure, seizures, jaundice, or vomiting.
Testing and Treating Sepsis – Safety Issues
-Sepsis should be treated as a medical emergency. In other words, sepsis should be treated as quickly and efficiently as possible as soon as it has been identified. This means rapid administration of antibiotics and fluids. A 2006 study showed that the risk of death from sepsis increases by and average of 7.6% with every hour that passes before treatment begins.
-The obvious risk factor is an infection. Any infection, from the tiniest source (a bug bite, a hangnail, etc.) to the more severe (pneumonia, meningitis, and so on), can trigger sepsis, which can lead to severe sepsis and septic shock. The infection can be bacterial, viral, fungal, or parasitic.
-Blood Tests: While no specific test diagnoses sepsis, the results can indicate the possibility of infection and/or how well the organs are functioning.
Lacate: Your organs may produce lactic acid when they are not receiving enough oxygen. This can be caused by intense exercise, heart failure, or serious infection, among other conditions. A high level of lactic acid caused by infection can be an important clue that you have sepsis.
C-reactive protein (CRP): C-reactive protein is produced by your body when there is an inflammation. The inflammation can be caused by several conditions, including infections.
Blood culture: A blood culture test is done to try to identify what type of bacteria or fungi has caused an infection in the blood. Blood cultures are collected separately from other blood tests and often they are taken more than once from different veins. It can take several days to get the results of a blood culture. Bacteria like growing in your body, but they don’t like growing in a culture bottle nearly as well. Only a third to a half of people with sepsis will have blood cultures that are positive, meaning that bacteria actually grow in the bottle.
Prothrombin time and partial thromboplastin time (PT and PTT), platelet count, and d-dimer: Sepsis can have serious affects on the blood clotting in your body. If the PT and PTT are too high it can indicate that your blood is not clotting well. Platelets are tiny cells in your blood that help to form blood clots. If your platelet count is too low, it can mean that your body is forming many unseen clots in tiny vessels all over your body, and this can be an important sign of sepsis. The d-dimer test also indicates that blood clotting is happening in your body. The level of d-dimer can be high if you have one large clot, or it can be high if your body is making many tiny clots, as happens in sepsis.
Confirmatory tests: Procalcitonin was performed on 9/24 2nd ER visit
Endotoxin is a component of certain bacteria and is released when the bacteria cell disintegrates. It should not be in your blood, so its presence confirms that there are gram-negative bacteria in your bloodstream, although this test cannot identify which type. This test is not a replacement for blood cultures.
Procalcitonin (PCT): Procalcitonin is a protein in your blood that rises if you have a bacterial infection. It cannot tell what type of bacterial infection you may have. If you have low levels of PCT, your doctor may rule out that your illness is caused by a bacterial infection and may be caused by a viral infection or an illness not related to an infection.
Urinalysis: Like the CBC, this simple urine test can tell your doctor a lot about your health, including if you have a urinary tract infection (UTI) or problems with your kidneys, such as a kidney stones. There is no special preparation to provide a urine sample for a urinalysis.
Urine culture: A urine culture is performed to determine what bacteria or fungi has caused a UTI. Urine for a culture must be obtained midstream. You will be given a special cleanser to wipe your genitals before you start urinating. Once you have done cleaned the area as instructed, urinate for a few seconds into the toilet and then place the container under the flow and collect the sample.
Treatment of Sepsis:
Antibiotics (usually more than one type) are prescribed by the physician based on the type of infection that is causing the illness. The first antibiotics are usually broad-spectrum, which means the antibiotic is effective against several of the more common bacteria. The antibiotics are given by intravenous in order to ensure they get into the blood system quickly and efficiently.
Antibiotics alone won’t treat sepsis; fluids are also needed. The body needs extra fluids to help keep the blood pressure from dropping dangerously low, throwing the patient into shock. Giving the fluids by IV allows the health care staff to track how much fluid is being administered and to control the type of fluid the patient is getting.
Ensuring the body has enough fluids helps the organs do their work and may reduce damage from sepsis.
While there are several types of IV fluids, some are standard in treating sepsis. Normal saline is one commonly given fluid. It is a crystalloid fluid. These are fluids that contain minerals, such as sodium, and are water-soluble, or dissolve in water. These add fluid to the blood system.
Oxygen – Patients are generally given oxygen, by mechanical ventilator, mask or nasal cannula, to ensure the body has enough oxygen in its system.
When a medical team suspects neonatal sepsis, they administer different tests such as blood/urine cultures to check for bacteria, blood tests to check for signs of infections, or a lumbar puncture to check for infections of the brain and spinal cord. If a doctor or medical staff suspects a neonatal infection, they will administer antibiotics as soon as possible. Early treatment is imperative in cases of neonatal sepsis. Doctors will typically begin administering antibiotics before they have received the results of tests. If a baby suffers neonatal sepsis and the parents suspect negligence was the cause, a birth injury lawyer can help them review their options.