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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

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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