What is an infection?

When organisms, such as bacteria, viruses, or fungi invade the body it is called infection. If the immunity of a baby is weakened, even an organism that occurs normally on the body can become infectious. An infection can affect some or all parts of the body, and can have varying degrees of severity. They can occur in lungs (pneumonia), blood (septicaemia), urinary tract, or in the fluid surrounding the spinal cord and the brain (meningitis).

What is neonatal sepsis?

Sepsis occurs when the body responds to an infection, usually septicaemia or blood stream infection. The symptoms are caused by chemicals or toxins from the infecting organism. This causes rapid generalised illness, shown as high body temperature, changes in blood pressure, or breathing difficulties.

Who is affected and what are the risk factors?

Preterm born babies are at higher risk for infections compared to term born babies. Infection can also affect the mother and be present at or soon after delivery. Generally the sicker the baby, the higher the risk of sepsis, and sepsis is particularly common when there are a lot of medical procedures (such as intravenous feeding lines).

What is the cause?

During the last three months  of pregnancy (third trimester), so called antibodies actively cross through the placenta from the mother to the foetus. This helps protecting the newborn baby from infections. Depending on the time of birth, a baby may have missed out this important transfer of antibodies in the womb. In addition to a preterm baby’s still immature immune system, this makes the baby more vulnerable to infection.

In some cases, bacteria are transferred to the baby during pregnancy or the birth process (for example following premature rupture of the amniotic membranes). Infection can also be transferred during  invasive medical procedures such as intravenous lines or breathing support by a mechanical ventilator. Some of these organisms rarely cause disease in older children or adults but cause the baby difficulties because of their immature immune system.

How is it diagnosed?

The medical team may consider an infection, when they recognise specific symptoms such as tiredness, fatigue, reduced responsiveness, fever, breathing difficulties, and reduced blood circulation. To diagnose an infection, blood or urine will be sampled for analysis. A lumbar puncture, also called spinal tap, may be performed to look for signs of an infection in the cerebrospinal fluid (meningitis). By analysing these body fluids the medical team can identify the specific organism causing the infection. This is required to provide the optimal treatment. Radiography of the chest may also help to detect infection of the lungs (pneumonia).

How is it managed?

If an infection is suspected in a preterm born baby, antibiotics which cover the most likely possible causes may already be given before the diagnosis of infection. In general, infections are treated with antibiotics, antiviral therapy, or antifungal therapy, depending on the infection-causing organism. Therapy will last for a couple of days or even weeks. Due to the infectious disease the baby may also need additional support , such as intravenous fluids, tube feeding, or breathing support.

© 2018 EFCNI - European Foundation for the Care of Newborn Infants
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