Neonatal Sepsis

Basics

Description

Mechanism
  • 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

Sepsis
  • 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

Meningitis
  • 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

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