Why in News?
Sepsis remains the second-leading cause of neonatal mortality in developing nations like India, accounting for nearly 30%–40% of all newborn deaths (approx. 200,000–250,000 avoidable deaths annually).
Classification & Types
Neonatal sepsis is categorized into two main groups based on when the symptoms manifest:
- Early-Onset Sepsis (EOS):
- Occurs within 72 hours of birth.
- Caused by vertical transmission—pathogens acquired from the mother's genital tract or placenta before or during labour.
- Late-Onset Sepsis (LOS):
- Occurs after 72 hours up to 90 days of life.
- Caused by horizontal transmission—pathogens acquired from the hospital environment (nosocomial), caregivers, or community contact.
Risk Factors
- Maternal Factors (For EOS)
- Prolonged Rupture of Membranes (PROM): Amniotic bag breaking more than 12–18 hours before delivery.
- Maternal Fever or Infection: Chorioamnionitis (infection of the placenta and amniotic fluid).
- Foul-smelling amniotic fluid during labour.
- Neonatal Factors (For LOS)
- Premature Birth & Low Birth Weight: Immature immune systems and underdeveloped skin barriers.
- Invasive Procedures: Prolonged use of catheters, feeding tubes, or mechanical ventilators in Neonatal Intensive Care Units (NICUs).
- Birth Asphyxia: Lack of oxygen at birth that disrupts the infant’s natural defences.
Major Biological Causes
- Bacteria: Most common culprit, including Klebsiella pneumoniae, Escherichia coli (E. coli), Group B Streptococcus (GBS), and Staphylococcus aureus.
- Viruses: Herpes Simplex Virus (HSV), enteroviruses, and adenoviruses.
- Fungi: Candida species, particularly common in long-term ICU-admitted preterm infants.
Clinical Symptoms to Watch For
Signs are often subtle and non-specific, frequently mimicking general newborn adjustment issues:
- Feeding Changes: Poor feeding, reduced sucking, or reluctance to feed.
- Temperature Instability: Hypothermia (abnormally low body temperature) or fever.
- Breathing Issues: Rapid breathing, grunting, shortness of breath, or apnea (temporary cessation of breathing).
- Skin Changes: Jaundice (yellowing eyes/skin), paleness, or mottled, bluish skin tone.
- Neurological Signs: Lethargy, excessive sleepiness, extreme irritability, floppy body movements, or seizures.
- Gastrointestinal Issues: Vomiting, diarrhoea, or a visibly swollen belly.
Diagnosis & Screening
- Blood Cultures: Considered the gold-standard test, though results take 24–48 hours.
- Sepsis Screen: A panel of rapid tests evaluating Total Leukocyte Count (TLC), Absolute Neutrilphils, C-Reactive Protein (CRP), and platelet count.
- Lumbar Puncture (Spinal Tap): Performed to test cerebrospinal fluid if newborn meningitis is suspected.
Treatment & Long-Term Complications
- Empirical Antibiotics: Immediate intravenous (IV) broad-spectrum antibiotics are given even before culture results are out.
- Supportive Care: Oxygen support, intravenous fluids, and maintaining optimal body temperature via incubators.
- Long-Term Impact: Surviving infants—especially preterm ones—can experience chronic lung disease, neurodevelopmental delays, cerebral palsy, or hearing and vision impairments.
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