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- Clinical syndrome characterized by systemic infection occurring within the first 28 days of life
- Early-onset sepsis (EOS) and late-onset sepsis (LOS) occur within and following the first 72 hours of life, respectively.
- Some consider infection within the first 7 days of life early onset, especially in term infants who are not hospitalized.
- EOS: 1/1,000 live births in the United States. Incidence is much higher among very-low-birth-weight (VLBW) neonates.
- LOS: Among febrile neonates presenting to the emergency department, approximately 12% are diagnosed with a serious bacterial infection. Incidence among hospitalized preterm infants is inversely associated with birth weight.
- Neonates are at increased risk for infection due to their immature immune system (permitting relative immune tolerance) and their developing, under-keratinized cutaneous barrier.
- Maternal factors:
- Low socioeconomic status
- Illicit substance use
- Inadequate or no prenatal care
- Poor maternal nutrition
- Intra-amniotic procedures
- Preterm labor, prolonged or premature rupture of membranes
- Chorioamnionitis or “intrauterine inflammation, infection, or both” (III, “triple I”; a new term describing the heterogenous conditions labeled previously as chorioamnionitis)
- Presence of cervical cerclage
- Septic/traumatic delivery
- Peripartum infection, including urinary tract infections (UTIs)
- Group B Streptococcus (GBS) colonization
- Ingestion of contaminated foods during pregnancy (Listeria)
- Infant factors:
- Male sex
- Prematurity or low birth weight
- Low Apgar scores
- Congenital anomalies
- Compromised skin integrity
- Galactosemia (Escherichia coli sepsis)
- Invasive procedures,
- Presence of central line
Single nucleotide polymorphisms (SNPs) in genes involved in inflammation have been linked to increased risk of neonatal sepsis.
- Recognition and treatment of maternal peripartum infections and colonization (i.e., GBS)
- General obstetric practices to reduce risk of chorioamnionitis/III and postnatal clean cord care
- Thermoregulation and early breastfeeding
- Hand hygiene, avoidance of fomites
- EOS: primarily vertical transmission, with ante- or intrapartum acquisition of bacteria colonizing the maternal genitourinary tract
- LOS: primarily due to horizontal transmission or nosocomial infection in hospitalized infants
- GBS is most common (~40%), followed by E. coli (~20–30%), other streptococci (~10%).
- Incidence of GBS disease has decreased since initiation of intrapartum antibiotic prophylaxis (IAP).
- E. coli is the most common pathogen in VLBW infants.
- Overall incidence of Listeria sepsis is low, but it is more common in preterm infants.
- Viral pathogens, including enteroviruses, may present with EOS.
- GBS and E. coli remain important; consider Staphylococcus aureus (up to a quarter methicillin-resistant) and coagulase-negative staphylococci (CoNS), especially in hospitalized infants.
- Pseudomonas aeruginosa carries the highest mortality risk in preterm infants (up to 75%).
- Yeast infections should be considered, with hospitalized preterm infants at greatest risk.
- Viral pathogens, including enteroviruses, may present with LOS; viral meningitis is more common in the late-onset period.
- Perinatally acquired HSV infection should be considered in neonates at any period during the 1st month of age.
Commonly Associated Conditions
- Meningitis: Up to a quarter of neonates with bacteremia have meningitis.
- Severe hyperbilirubinemia
- Persistent pulmonary hypertension of the newborn (PPHN)
- Patent ductus arteriosus (PDA)