Neonatal sepsis is a serious condition that affects newborns, posing a significant threat to their health and well-being. It is crucial to raise awareness about this condition to ensure early detection and take appropriate measures for prevention and treatment. In this blog, we will explore various aspects of neonatal sepsis, including its significance, prevalence, causes, symptoms, preventive measures, diagnosis, and treatment.

On 13th September, which is World sepsis day, we had the opportunity to engage in a live discussion with Dr. Gaurav Agarwal ,MBBS, MD (Pediatrics) , with a Fellowship in Neonatal Perinatal Medicine from RCPSC-Canada and PGPN (USA). He serves as a Consultant Neonatologist & NICU Incharge at Kailash Hospital, Greater Noida. With over 10 years of experience, he specializes in treating child and newborn health issues, overseeing the NICU unit, and caring for sick term/preterm newborns. His passions include managing newborn infections, neuroimaging and Neonatal resuscitation. Here is an excerpt from the live session.

Raising Awareness About Neonatal Sepsis

Creating awareness about neonatal sepsis is of paramount importance, as it can profoundly impact the health and well-being of newborns. Here’s why raising awareness is crucial:

• Reducing Mortality Rates: Neonatal sepsis is a leading cause of newborn deaths worldwide. By raising awareness and ensuring early diagnosis, many newborn lives can be saved, especially in regions where healthcare resources are limited.
• Early Detection and Treatment: Awareness campaigns educate parents, caregivers, and healthcare providers about the signs and symptoms of neonatal sepsis. Early detection is vital for timely intervention and effective treatment, significantly increasing the chances of recovery.
• Support for Parents: Neonatal sepsis can be emotionally challenging for parents. Awareness campaigns provide support by connecting them with resources, support groups, and a network of individuals who have experienced similar challenges.

Prevalence of Neonatal Sepsis Worldwide

Neonatal sepsis represents a significant global health concern,standing as one of the leading causes of neonatal mortality, particularly in low- and middle-income countries.

Worldwide, neonatal sepsis affects approximately 1 to 50 out of every 1,000 live births and contributes to 3-30% of infant and child deaths annually.

Causes of Neonatal Sepsis

• Bacterial Infections: Bacterial pathogens stand as the primary cause of neonatal sepsis. These infections can stem from various sources, including the mother’s genital tract, medical procedures, or the environment.
• Viral Infections: Although less common compared to bacterial infections, viral infections such as herpes simplex virus (HSV) or cytomegalovirus (CMV) can also contribute to neonatal sepsis.
• Fungal Infections: Neonatal sepsis caused by fungi is relatively rare but can occur, often in premature infants or those with compromised immune systems.
• Nosocomial Infections: In certain instances, neonatal sepsis is acquired within the hospital , known as nosocomial sepsis. This can occur due to exposure to healthcare-associated infections.

Risk Factors Associated with Neonatal Sepsis

• Premature Birth: Premature infants have underdeveloped immune systems, making them more susceptible to infections, including sepsis.
• Low Birth Weight: Infants with low birth weight , especially those born with very low birth weight, face an increased risk of neonatal sepsis.
• Maternal Infections: Mothers with infections, such as urinary tract infections, sexually transmitted infections, or chorioamnionitis (infection of the fetal membranes), can transmit pathogens to the baby during birth.
• Prolonged Rupture of Membranes: When the amniotic sac ruptures (water breaks) for an extended period before birth, it can increase the risk of infection in the newborn.
• Invasive Medical Procedures: Invasive procedures, such as catheter placement or ventilator use, can introduce pathogens into the baby’s body and raise the risk of sepsis.
  Maternal Group B Streptococcus (GBS) Colonization: If the mother is colonized with GBS in the genital tract, there is a risk of transmitting the bacterium to the baby during birth.
• Maternal Fever during Labor: A high maternal fever during labor can indicate an infection, and if left untreated, it can increase the risk of neonatal sepsis.
• Multiple Births: Twins or higher-order multiple births can be associated with an increased risk of neonatal sepsis.
• Maternal Factors: Maternal factors, such as young maternal age, poor prenatal care, and certain medical conditions, can influence the risk of neonatal sepsis.
• Inadequate Hygiene Practices: Poor hygiene practices during childbirth and neonatal care can contribute to the transmission of pathogens. It’s important to emphasize that prevention, early detection, and timely treatment are crucial in addressing neonatal sepsis. Healthcare professionals implement a range of precautions, including maternal screening and the administration of antibiotics, to mitigate the risks associated with GBS and other pathogens. Education and awareness play a pivotal role in reducing the incidence of neonatal sepsis.

Diagnosis of Neonatal Sepsis

Clinical Assessment: Healthcare professionals initiate the diagnostic process by assessing the clinical signs and symptoms of the newborn. These may include fever or hypothermia, poor feeding, lethargy, irritability, rapid breathing, and abnormal heart rate.

Laboratory Tests:

• Blood Culture: The primary diagnostic test for neonatal sepsis involves taking a blood sample from the baby and incubating it to identify the presence of bacteria or other pathogens.
• Complete Blood Count (CBC): A CBC measures various components of the blood, including the number of white blood cells. An abnormal white blood cell count can serve as an indicator of infection
• C-reactive Protein (CRP): Elevated levels of these blood markers can indicate the presence of an infection, aiding in the diagnosis.

Lumbar Puncture: If there are concerns about central nervous system involvement, a lumbar puncture (spinal tap) may be performed to assess cerebrospinal fluid for signs of infection.
Radiological Imaging: In some cases, imaging studies such as X-rays or ultrasounds may be employed to evaluate potential complications related to sepsis, such as pneumonia or abscesses.
Assessment of Risk Factors: Healthcare providers take into account risk factors, such as maternal health, prematurity, and birth circumstances, when assessing the likelihood of neonatal sepsis.

Treatment Options for Neonatal Sepsis

• Antibiotic Therapy: When neonatal sepsis is suspected or confirmed, immediate administration of antibiotics is crucial. The choice of antibiotics depends on the suspected pathogen and local antibiotic resistance patterns. Broad-spectrum antibiotics are often initiated initially and then adjusted based on culture results.
• Supportive Care: Neonates with sepsis may require supportive care, including oxygen therapy and respiratory support. Ensuring adequate hydration and nutrition is essential to support the baby’s immune system and aid in recovery.
• Monitoring: Continuous monitoring of vital signs and clinical condition is essential to track the baby’s response to treatment and to detect any complications.
• Intravenous (IV) Therapy: IV therapy is commonly used to administer antibiotics, fluids, and other medications directly into the bloodstream, ensuring prompt delivery of treatment.
• Treatment Duration: The duration of antibiotic therapy varies depending on the specific pathogen, the baby’s clinical response, and the culture results. Treatment may range from several days to several weeks.
• Further Investigations: Additional tests and investigations may be conducted to determine the source of the infection, such as imaging studies or further blood tests.
• Preventive Measures: Preventive measures are also crucial in managing neonatal sepsis. This includes maternal screening and treatment for Group B Streptococcus (GBS), improving infection control practices in neonatal units, and promoting breastfeeding for enhanced immune protection.

Preventive Measures for Expectant Mothers and Caregivers

Preventive measures for expectant mothers and caregivers play a vital role in reducing the risk of neonatal sepsis and ensuring the health and well-being of newborns. Here are essential steps and practices to consider:

For Expectant Mothers

• Prenatal Care: Early and regular prenatal care is crucial. Attend all scheduled prenatal check-ups to monitor your health and the baby’s development. This includes screenings for infections and other risk factors.
• Group B Streptococcus (GBS) Screening: Expectant mothers should undergo GBS screening around the 35th to 37th week of pregnancy. If GBS is detected, antibiotics are administered during labor to reduce the risk of transmission to the baby.
• Vaccinations: Ensure you are up to date on vaccinations, including the flu vaccine and the Tdap (tetanus, diphtheria, and pertussis) vaccine. These vaccines can protect both you and your baby from preventable infections.
• Maintain Good Hygiene: Practice proper personal hygiene, including regular handwashing. This helps reduce the risk of introducing infections to your baby during handling and care.
• Avoid Tobacco and Alcohol: Refrain from smoking and consuming alcohol during pregnancy, as these substances can weaken the baby’s immune system and increase infection risk.
• Nutrition: Maintain a balanced and nutritious diet to support your baby’s immune system development. Consult with your healthcare provider about any necessary supplements.
• Avoid Close Contact with Sick Individuals: Minimize close contact with individuals who are ill or exhibit signs of infections, especially during pregnancy.
• Prevent Urinary Tract Infections (UTIs): Promptly seek treatment for any urinary tract infections during pregnancy, as untreated UTIs can increase the risk of infection.

For Caregivers and New Parents

• Breastfeeding: If possible, exclusively breastfeed your baby. Breast milk contains antibodies and nutrients that help boost the baby’s immune system and protect against infections, including sepsis.
• Proper Handwashing: Caregivers and family members should practice thorough handwashing before handling the baby and their belongings. This reduces the risk of introducing pathogens.
• Immunizations: Ensure that the baby receives all recommended vaccines on schedule. Immunizations can protect against several infections.
• Safe Sleep Practices: Follow safe sleep guidelines to reduce the risk of sudden infant death syndrome (SIDS) and prevent accidental suffocation or strangulation.
• Hygiene and Sanitation: Maintain a clean and hygienic environment for the baby. Regularly clean and disinfect surfaces, baby equipment, and toys.
• Early Breast Milk Expression: If the mother is unable to breastfeed immediately, consider early expression and feeding the baby with expressed breast milk. This provides the baby with immune-boosting benefits.
• Promptly Address Illness: If you notice any signs of illness in the baby, such as fever, poor feeding, or unusual fussiness, seek immediate medical attention. Early diagnosis and treatment are vital.
• Create a Smoke-Free Environment: Ensure that the baby’s environment is free from tobacco smoke and other environmental toxins.
• Limit Visitors: During the early weeks, limit the number of visitors to reduce the baby’s exposure to potential infections. Encourage visitors to practice good hygiene.

Human Milk: Reducing the Risk of Infections, Including Sepsis

Breast milk provides essential nutrients and antibodies that play a pivotal role in protecting infants from infections, including sepsis. It is a cornerstone in boosting a baby’s immune system and diminishing the risk of severe infections. Human milk comprises a range of antibodies, immunoglobulins, and immune cells that actively combat infections. These components grant passive immunity to the baby , shielding them from a broad spectrum of pathogens. Human milk has been demonstrated a significant reduction the risk of necrotizing enterocolitis (NEC), a severe gastrointestinal infection frequently observed in preterm infants, which can lead to sepsis.

The immune-boosting and protective properties of human milk, whether from the mother or a donor, establish it as the preferred choice for preterm infants, especially those susceptible to sepsis .It not only supports their immediate health but also yields long-term benefits for their development and well-being.

Stay informed and take a proactive approach to ensure the well-being of our youngest and most vulnerable members of society.

References

• Ershad M, Mostafa A, Dela Cruz M, Vearrier D. Neonatal Sepsis. Curr Emerg Hosp Med Rep. 2019;7(3):83-90. doi:10.1007/s40138-019-00188-z
• Afsharpaiman S, Torkaman M, Saburi A, Farzaampur A, Amirsalari S, Kavehmanesh Z. Trends in incidence of neonatal sepsis and antibiotic susceptibility of causative agents in two neonatal intensive care units in tehran, I.R iran. J Clin Neonatol. 2012;1(3):124-130. doi:10.4103/2249-4847.101692
• Altobelli E, Angeletti PM, Verrotti A, Petrocelli R. The Impact of Human Milk on Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis. Nutrients. 2020;12(5):1322. Published 2020 May 6. doi:10.3390/nu12051322