Early and late sepsis
The division by time period is not a formality: the probable pathogens and the choice of antibiotics depend on it. Early sepsis begins in the first three days and is associated with microorganisms that the child receives from the mother during childbirth or when amniotic fluid is infected; The leading pathogens are group B streptococcus and Escherichia coli. Late sepsis develops after the third day and is often associated with a long hospital stay, vascular catheters, artificial ventilation, and in children at home - with infection of the skin, umbilical wound or urinary tract.
- Early sepsis - first 72 hours of life
- Source: mother’s birth canal and amniotic fluid
- Late sepsis - after the third day
- Associated with catheters, wounds, nosocomial flora
- Possible after discharge home
Risk factors
The main one is prematurity: the shorter the period, the weaker the protection. During labor, the risk is increased by prolonged anhydrous periods, maternal fever and infection, detected carriage of group B streptococcus without antibiotic prophylaxis, prolonged labor, and multiple vaginal examinations. After birth, vascular catheters, prolonged ventilation, operations, and caring for the baby without thorough hand washing are important. Hand hygiene remains the simplest and most effective preventive measure.
- Prematurity and low birth weight
- Anhydrous interval of more than 18 hours
- Fever in mother during labor
- Carriage of group B streptococcus without prophylaxis
- Vascular catheters and ventilation
- Hygiene violations when caring for a baby
Symptoms
A newborn does not have the typical infection pattern that adults are accustomed to. Often the first and only sign is the feeling of the parents or nurse that the child has become “different”: he moves less, sucks sluggishly, sleeps unusually. The temperature can either rise or fall, which is no less alarming. Rapid or uneven breathing, pauses in breathing, gray or marbled skin color, bloating, regurgitation, jaundice that appears or intensifies for no reason are added. If the membranes of the brain are damaged, convulsions and bulging of the fontanel are possible.
- Lethargy and decreased activity
- Poor sucking, refusal to eat
- Unstable body temperature
- Rapid breathing, apnea, groaning
- Gray or marbled skin color
- Bloating, regurgitation
- Increased jaundice
- Cramps due to meningitis
Diagnostics
The examination begins immediately and treatment is not delayed to complete it. Before the first dose of antibiotic is administered, blood is taken for culture - this is the only way to identify the pathogen and select the exact drug. A clinical blood test, C-reactive protein and procalcitonin help assess the severity of inflammation, and the dynamics of the indicators is more informative than a single result. Urine analysis and culture, and chest x-ray for respiratory problems are required. If meningitis is suspected, a lumbar puncture is performed: in newborns it often accompanies sepsis and requires a different duration of treatment.
- Blood cultures before starting antibiotics
- Clinical blood test with formula
- C-reactive protein and procalcitonin dynamics
- Urine analysis and culture
- Chest X-ray
- Lumbar puncture for suspected meningitis
- Culture of discharge from foci of infection
Treatment and prevention
Treatment is carried out only in a hospital. Broad-spectrum antibiotics are administered intravenously as early as possible, and after obtaining a culture, they switch to a drug to which the pathogen is sensitive. At the same time, breathing and circulation are supported, fluids are administered, glucose and electrolytes are monitored, and ventilation is used if necessary. The duration of the course is determined by the doctor: with meningitis it is longer. Prevention begins before birth - this includes examination of the pregnant woman, antibiotics during childbirth if she is carrier of group B streptococcus, and after birth - hand hygiene, umbilical wound care and breastfeeding.
- Immediate initiation of intravenous antibiotics
- Correction of therapy based on culture results
- Breathing and Circulatory Support
- Fluid therapy and glucose control
- Antibiotic prophylaxis during childbirth according to indications
- Careful hand hygiene when caring
- Breastfeeding as a protective factor