Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection

with or without accompanying bacteremia in the first month of life. It encompasses various
systemic infections of the newborn such as septicemia, meningitis, pneumonia, arthritis,
osteomyelitis, and urinary tract infections. Neonatal infections, which may be caused by bacteria,
viruses, or fungi, occur as early or late infections and their timing gives care providers clues for
determining causative agents.
4,5
The incidence of neonatal sepsis according to the data from National Neonatal Perinatal
Database (NNPD, 2002-03) is 30 per 1000 live births. According to the World Health Organi-
zation (WHO), 130 million children are born yearly, and about 4 millions die every year, while
infection causes 36% of these deaths; this is even worse in countries where critical patient
resources are limited.
5,6
Neonatal sepsis may be categorized as early or late onset. Eighty-five percent of
newborns with early-onset infection present within 24 hours, 5% present at 24-48 hours, and a
smaller percentage of patients present within 48-72 hours. Factors that might increase the risk of
community-acquired late onset sepsis include poor hygiene, poor cord care, bottle-feeding, and
prelacteal feeds. In contrast, breastfeeding helps in prevention of infections. Neonates with sepsis
may present with one or more of the following symptoms and signs is hypothermia or fever
(former is more common in preterm low birth weight infants), Lethargy, refusal to suck, poor
perfusion, prolonged capillary refill time, Hypotonia, absent neonatal reflexes, Bradycardia or
tachycardia, respiratory distress (apnea and gasping respiration), Hypoglycemia or
hyperglycemia and Metabolic acidosis.
4,5,6,7
The maternal history may provide important information about maternal exposure to
infection, maternal immunity (natural or acquired), maternal colonization, and obstetric risk
factors (prematurity, prolonged ruptured membranes, maternal chorioamnionitis). Sexually
transmitted diseases (STDs) that infect a pregnant woman are of particular concern to the fetus
and newborn because of the possibility for intrauterine or perinatal transmission.
5
Used to evaluate for early-onset and late-onset sepsis include a complete blood count
(CBC) and differential, blood and cerebrospinal fluid (CSF) cultures, and measurement of levels
of C-reactive protein (CRP) and possibly other infection markers. Blood culture it is the gold
standard for diagnosis of septicemia and should be performed in all cases of suspected sepsis
prior to starting antibiotics. A positive blood culture with sensitivity of the isolated organism is
the best guide to antimicrobial therapy. Complete Blood Count and differential may be ordered
serially to determine changes associated with the infection (eg, thrombocytopenia or
neutropenia) or to monitor the development of a left shift or changes in the ratio of immature to
total neutrophils. levels of CRP, an acute-phase protein associated with tissue injury, are elevated
at some point in 50-90% of infants with systemic bacterial infections. Cerebrospinal fluid (CSF),
the clinical features of septicemia and meningitis often overlap; it is quite possible to have
meningitis along with septicemia without any specific symptomatology.
4,5,6
A neonate with sepsis may require treatment aimed at the overwhelming systemic effects
of the disease. Cardiopulmonary support and intravenous (IV) nutrition may be required during
the acute phase of the illness until the infants condition stabilizes. Monitoring of blood pressure,
vital signs, hematocrit, platelets, and coagulation studies is vital. Not uncommonly, blood
product transfusion, including packed red blood cells (PRBCs), platelets, and fresh frozen
plasma (FFP), is indicated. There cannot be a single recommendation for the antibiotic regimen
of neonatal sepsis for all settings. The choice of antibiotics depends on the prevailing flora in the
given unit and their antimicrobial sensitivity. Cephalosporins are attractive in the treatment of
nosocomial infection because of their lack of dose-related toxicity and their ability to reach
adequate serum and cerebrospinal fluid (CSF) concentrations; however, their use has led to
resistance in gram-negative organisms.
4,8
With early diagnosis and treatment, term infants are not likely to experience long-term
health problems associated with neonatal sepsis; however, if early signs or risk factors are
missed, mortality increases. Residual neurologic damage occurs in 15-30% of neonates with
septic meningitis.
4,5
Mortality from neonatal sepsis may be as high as 50% for infants who are not treated.
Infection is a major cause of fatality during the first month of life, contributing to 13-15% of all
neonatal deaths. Low birth weight and gram-negative infection are associated with adverse
outcomes. Neonatal meningitis occurs in 2-4 cases per 10,000 live births and contributes
significantly to mortality from neonatal sepsis; it is responsible for 4% of all neonatal deaths.
4,6