Neonatal sepsis

Background

Microbiology

• Group B Streptococcus
• Escherichia coli
• Other gram-negative bacteria

Pathophysiology

• Thought to be generally acquired vertically during birth from the genitourinary tract

Clinical Manifestations

• May be just a fever
• Fussiness, lethargy, behavioural changes, decreased in frequency and volume of wet diapers, decreased feeding
• Tachypnea, tachycardia, fever, signs of dehydration, neurologic signs, increased work of breathing, jaundice
• WBC and CRP may be normal early in the course of illness despite severe bacterial infection

Management

• An axillary temperature higher than 37.5ºC (rectal greater than 38ºC) in an infant younger than 3 months older should be investigated
• The PECARN Step by Step approach can be used to identify patients at low risk, based on general appearance, age ≤21 days, leukocyturia, procalcitonin ≥0.5 ng/mL, and CRP > 20 mg/L or ANC > 10