Neonatal sepsis, early-onset

An infectious disorder of newborn infants that is characterized by a systemic inflammatory response within 72 hours of life and is most commonly caused by bacteria.

Neonatal sepsis refers to a severe infection that affects newborn infants, especially during the initial days after birth. Early-onset neonatal sepsis, in particular, is characterized by the manifestation of an infectious process within the first 72 hours of life. The condition often arises due to bacterial infections, eliciting a pronounced systemic inflammatory response in the affected infant.

Definition and Classification

Neonatal sepsis can be broadly classified into:

• Early-Onset Neonatal Sepsis (EONS): Manifests within the first 72 hours of life.
• Late-Onset Neonatal Sepsis (LONS): Occurs after 72 hours post-birth.

This article primarily focuses on early-onset neonatal sepsis.

Causes

While neonatal sepsis can be caused by a variety of pathogens, including viruses, fungi, and parasites, the vast majority of cases of EONS are bacterial in origin. Common bacterial culprits include:

• Group B Streptococcus (GBS): A primary cause of EONS.
• Escherichia coli: Another significant causative agent.
• Listeria monocytogenes
• Haemophilus influenzae

Transmission often occurs from mother to infant during childbirth, especially if the mother has a vaginal infection.

Clinical Presentation

Symptoms of EONS can be subtle but may include:

• Fever or low temperature
• Respiratory distress
• Cyanosis (blueish skin coloration)
• Lethargy or irritability
• Poor feeding
• Abdominal distension
• Jaundice

Diagnosis

A prompt diagnosis is crucial to optimize outcomes. Typical diagnostic measures include:

• Blood Cultures: To identify the causative organism.
• Complete Blood Count (CBC): Might show elevated or reduced white blood cell counts.
• C-Reactive Protein (CRP): A marker of inflammation that may be elevated in sepsis.
• Lumbar Puncture: To evaluate for meningitis, a complication of sepsis.
• Chest X-ray: To rule out pneumonia.

Management

• Antibiotic Therapy: Empirical antibiotics are initiated promptly after obtaining cultures. The regimen can be adjusted based on culture results.
• Supportive Care: This may include oxygen therapy, intravenous fluids, and other supportive measures.
• Close Monitoring: Vital signs, laboratory parameters, and overall well-being need constant observation.

Prognosis

With timely diagnosis and appropriate treatment, many infants with EONS recover fully. However, delays in treatment can lead to complications, including meningitis, organ dysfunction, or even death.

Prevention

Several preventive measures can reduce the risk of EONS:

• Maternal Screening: Screening pregnant women for Group B Streptococcus and other infections.
• Intrapartum Antibiotics: Administering antibiotics to mothers during labor if they test positive for high-risk bacteria.
• Good Hand Hygiene: Ensuring all those handling the infant maintain stringent hand hygiene.

Summary

Early-onset neonatal sepsis remains a significant concern in neonatal care. Rapid identification and prompt therapeutic intervention are paramount to ensure the best possible outcomes for affected infants. Continued research and public health initiatives are vital in further reducing the incidence and impact of this condition.

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