Neonatal Sepsis

Description

• Life-threatening infection of the newborn, rarely occurring as late as 3 mo of age
• Overwhelmingly bacterial:
  • Rarely viral or fungal infection
  • Organisms usually present in the maternal perineal flora
• Occurs in 3–5 newborns per 1,000 live births
• Risk factors:
  • Perinatal:
    • History of recent fever (>37.5°C)
    • UTI
    • Chorioamnionitis
    • Prolonged rupture of membranes (PROM) (>18 hr)
    • Foul lochia
    • Uterine tenderness
    • Intrapartum asphyxia
  • Neonatal:
    • Prematurity
    • Fetal tachycardia (>180 beats/min)
    • Male
    • Twinning (esp second twin)
    • Developmental or congenital immune defects
    • Administration of IM iron
    • Galactosemia
    • Congenital anomaly (urinary tract, asplenia, myelomeningocele, sinus tract)
    • Omphalitis

Etiology

• Bacterial:
  • Group B Streptococcus
  • Escherichia coli
  • Listeria monocytogenes
  • Coagulase-negative Staphylococcus
  • Treponema pallidum
• Viral:
  • Herpes simplex is a common viral etiology
  • Enterovirus
  • Adenovirus
• Fungi:
  • Candida species
• Protozoa:
  • Malaria
  • Borrelia

• Bacterial:
  • Group B Streptococcus
  • E. coli type K1
  • L. monocytogenes
  • Other Streptococci
  • Nontypeable Haemophilus influenzae
  • Coagulase-positive and coagulase-negative Staphylococcus
  • Less commonly: Klebsiella, Enterobacter
  • Pseudomonas, T. pallidum, and Mycobacterium tuberculosis
  • Citrobacter diversus (important cause of brain abscess)
  • Additional pathogens: Mycoplasma hominis and Ureaplasma urealyticum
• Viral:
  • Enteroviruses
  • Herpes simplex virus (type 2 more commonly)
  • Cytomegaloviruses
  • Rubella
  • HIV
• Toxoplasma gondii
• Fungi:
  • Candida albicans and other fungi