Neonatal Sepsis

Neonatal sepsis is a clinical syndrome of bacteremia with systemic signs and symptoms of infection occurring in infants during the first 28 days of life. It poses a significant risk of morbidity and mortality globally.

Types of Neonatal Sepsis

Type	Onset	Common Pathogens	Sources
Early-Onset Sepsis (EOS)	Within 72 hours of birth	GBS, E. coli, Listeria monocytogenes	Vertical transmission (mother to child)
Late-Onset Sepsis (LOS)	After 72 hours to 28 days	S. aureus, Coagulase-negative staph, Klebsiella, Pseudomonas, Candida	Horizontal transmission (hospital or community-acquired)

Etiology and Risk Factors

Maternal Risk Factors (Especially for EOS)

Prolonged rupture of membranes (>18 hours)
Maternal chorioamnionitis
Preterm labor (<37 weeks)
Maternal fever or urinary tract infection
GBS colonization without prophylaxis

Neonatal Risk Factors (Especially for LOS)

Prematurity
Low birth weight (<1500g)
NICU admission
Invasive procedures (e.g., IV lines, intubation)
Formula feeding instead of breastfeeding

Clinical Manifestations

Symptoms are often vague and non-specific in neonates.

Temperature instability (fever or hypothermia)
Poor feeding
Lethargy or irritability
Respiratory distress (apnea, grunting, retractions)
Cyanosis
Seizures
Abdominal distension
Jaundice
Hypotension
Bradycardia or tachycardia

Diagnostic Workup

Blood cultures (before antibiotic initiation)
CBC with differential: Leukocytosis, neutropenia, thrombocytopenia
CRP / Procalcitonin: Inflammatory markers
Lumbar puncture: Rule out meningitis
Urine culture
Chest X-ray: If respiratory symptoms are present

Medical Management

Empiric Antibiotics:

EOS: Ampicillin + Gentamicin
LOS: Vancomycin + Cefotaxime or Gentamicin

Tailor therapy based on local antibiogram and culture results.

Supportive Care:

IV fluids and electrolyte management
Respiratory support (oxygen, CPAP, or ventilation)
Thermoregulation
Monitoring for DIC, hypoglycemia, or metabolic acidosis

Nursing Management and Interventions

1. Monitor Vital Signs Closely

Assess for temperature instability, respiratory rate, HR, BP, and oxygen saturation.
Report any signs of clinical deterioration.

2. Maintain Thermoregulation

Use radiant warmers or incubators.
Avoid exposure and monitor for hypothermia, a subtle early sign of sepsis.

3. Administer Medications as Ordered

Follow strict timing for antibiotic administration.
Ensure proper dosing based on weight and renal function.

4. Monitor for Signs of Complications

Watch for signs of meningitis, DIC, or shock.
Report abnormal neurological findings (e.g., irritability, seizures).

5. Ensure Adequate Nutrition and Fluids

Administer IV fluids or encourage breastfeeding if stable.
Monitor I&O, daily weight, and signs of fluid overload or dehydration.

6. Infection Control Measures

Practice strict hand hygiene and use aseptic techniques.
Limit invasive procedures and handle lines with care.

7. Educate and Support Parents

Offer emotional support and explain the treatment plan.
Encourage involvement in care (e.g., skin-to-skin, kangaroo care if possible).

High-Yield NCLEX/USMLE Pearls

Focus Area	Key Fact
GBS Prevention	Maternal screening at 35–37 weeks and intrapartum antibiotics if positive
Common Organisms (EOS)	GBS, E. coli, Listeria
Common Organisms (LOS)	S. aureus, Coagulase-negative Staph, Candida
Signs in Preterms	Often present with apnea, lethargy, and poor feeding
First-line Antibiotics (EOS)	Ampicillin + Gentamicin
Sepsis + Meningitis	Add Cefotaxime, avoid Ceftriaxone due to biliary sludging
CSF Evaluation	Mandatory if neurologic symptoms are present
Nursing Priority	Monitor for thermoregulation, respiratory changes, perfusion status
Procalcitonin vs CRP	Procalcitonin rises earlier and is more specific in neonates

Prognosis

Better outcomes with early detection and appropriate therapy.
Risk of neurological deficits increases with delayed diagnosis or meningitis.
Preterm neonates are at higher risk of mortality and complications.