This scary incident happened to one of my friends about a decade ago. They just got home from the hospital when her newborn baby ran a fever and diarrhea. To make it worse, the mom developed the same symptoms along with rashes. They were quickly isolated (imagine how hard is the separation with her sick 10-day old baby). Her GP ruled out Black measles for her, and blood cultures showed that the baby had sepsis. It was such a terrifying kind of welcome for her prayed-for baby boy. But at least, they both pulled out of it and reunited after a couple of weeks.
Neonatal sepsis is a medical condition in babies caused by infections. It’s commonly due to bacteria and rarely fungi, parasites, or viruses. Babies may contract these infections in their mother’s tummy before, during, or after the delivery. Fever, vomiting, diarrhea, lethargy, poor appetite, and pale appearance are signs of sepsis. Some babies may also experience chills and extreme fussiness. It’s a life-threatening condition but is highly treatable with medication and proper clinical management.
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Causes of sepsis
Why do newborns contract sepsis? In my friend’s case, it was mainly because of her viral infection. It was deduced as exposure to the virus while they were in the hospital. Sepsis occurs either in the blood, urine, or the baby’s spinal fluid.
Bacterial infection is the common culprit in neonatal sepsis. But, since expecting moms today are screened and treated immediately, this problem is getting less prevalent. Here are the chances that increase the infant’s risk of bacterial sepsis.
In every hospital, pre-term babies are our little warriors. You will never see such a fighting spirit than with these little angels whose tiny bodies have to go through so much to survive. Some preemies even undergo blood transfusion to keep going. The good news is a majority of these warriors triumph in their fight.
Sadly, sepsis is the biggest factor in some preterm babies’ death. Infants with low birth weights are also at a higher fatal risk of sepsis.
Amniotic infection in mothers
Pregnant women sometimes suffer a condition called chorioamnionitis. It happens when the chorion and amnion membranes surrounding the fetus get infected with bacteria. The amniotic fluid, the fluid that causes the baby to float, sometimes also harbors the infection.
Chorioamnionitis often starts as a urinary tract infection in mothers. Some women are treated with antibiotics to combat it. But sometimes, the mother needs to undergo early delivery so that she and the baby can receive the necessary treatment they both need.
Premature and prolonged water breaking
When a pregnant woman’s water breaks, she would normally go into labor. But Premature Rupture of Membranes or PROM sometimes happens. It occurs when the mom’s amniotic sac breaks before the 37th week of her pregnancy. The earlier the water breaks, the more serious the complications it can cause her baby.
Infection, the baby’s pressure against the membrane, or past cervical surgeries can cause PROM. Smoking mothers also put their babies at a higher rate for sepsis. Sometimes, it PROM may also happen to mothers even without any risk factors at all.
If the rupture happens before the 34th week of the pregnancy, moms are likely put on bed rest and given steroidal medication. If it occurs sometime between the 34th to 37th week, doctors will induce labor to lower the risk of sepsis.
Strep infection in pregnant moms
Group B Streptococcus (GBS) are bacteria that can thrive in the female reproductive tract. Some women carry these bacteria without any problem or symptoms at all. However, to some women, it can cause an infection in the bloodstream and the placenta.
If a woman tests positive with GBS, antibiotics are administered during labor. For moms with the infection in their previous pregnancy, intravenous antibiotics are also given. Sepsis, pneumonia, or meningitis are common complications.
Prolonged hospital stay
Exposure to certain bacteria while in the hospital can cause the late onset of sepsis in newborns. And if your baby has a breathing tube, ventilator, or catheter, the risk for sepsis increases. Technically, they have not acquired the infection from the birth canal but from the medical equipment used.
Some antibiotics given to newborns may also allow fungi like Candida to flourish. Aside from sepsis, these fungi may also cause diaper rash or oral thrush infections.
Symptoms of sepsis in newborns
Early detection can do so much in helping babies with sepsis overcome the life-threatening condition. But what are the biggest signs that you should watch out for in your newborn? How do you know that your baby contracted the infection?
Here are the common signs and symptoms of sepsis:
- Pale and mottled skin
- Unstable body temperature
- Difficulty in breathing, or pauses in breathing (apnea)
- Vomiting and diarrhea
- Low urine output
- Lethargy and extreme sluggishness
- Swollen belly
It’s normal for mothers to go ballistic over symptoms that they read over the web. However, it is still your pediatrician that will rule out your baby’s condition. It’s best to remember that babies under three months of age do not necessarily run a fever. So, if your newborn baby has a temperature of over 100.4F or 38.1C, it is best to inform your doctor.
How do doctors diagnose sepsis?
Since sepsis mainly infects the blood, urine, or spinal fluid, the doctors will perform several tests based on the symptoms. The basic testing for sepsis is through blood culture, urine culture, or spinal tap.
The doctors will obtain body fluid samples and try to culture or “grow” them in the laboratory. From there, they can determine the specific cause of infection.
In some cases, confirmatory tests are also done. Nevertheless, intravenous antibiotic treatment usually starts as soon as the doctor rules out sepsis while waiting for test results. That’s because it will take several days for the results to come out. It will give your child a better chance of combating the infection.
When the specific pathogen is determined, the doctors will adjust the antibiotic needed for it.
Expect the following tests when sepsis is suspected in your baby:
- Blood culture
- Complete Blood Count (CBC)
- C-Reactive Protein
- Skin tests
- Stool and urine culture
- Lumbar puncture (spinal tap or fluid sampling)
- Chest X-ray
Sepsis is among the life-threatening illnesses that puts women and newborn babies at risk. According to the World Health Organization (WHO), it affects about 3 million newborns every year! This global figure is alarming, and we certainly would not want your children to become a part of it.
Basic hygiene practices are effective in preventing microbial transmission. In pregnant women, early detection is also very important. That’s why prenatal check-ups are a must. Moms with infections are treated immediately to prevent the sepsis risk.
If moms have chorioamnionitis or strep infection, then they may need to take preventive antibiotics. It is the same thing if she has already given birth to a baby with sepsis before.
How soon do I need to deliver my baby after my water breaks?
When the mother’s water breaks, she needs to deliver the baby within 24 hours. But the sooner her baby is delivered, the better. Otherwise, she will undergo induced labor or even C-section to lessen the possibility of infection for both of them.
If the hospital environment can cause sepsis, how will I trust giving birth in these institutions?
Hospitals and health care facilities are also at maximum efforts in providing a clean and sanitary place for the birthing place. The WHO continues to uphold the commitment of hospitals to provide a full-functioning infection prevention control team. Aside from the environment, they should make sure to use uncompromised and hygienic medical equipment.
Some babies who have sepsis suffer from developmental delay? Why is that so?
Meningitis, a complication of sepsis, is responsible for causing long-term problems in babies who have survived it. It may include hearing loss, seizures, or even cerebral palsy. Early treatment prevents this complication from happening. Babies will grow up fine and without any developmental trouble at all.
I have chorioamnionitis. What should I expect?
More often, newborn babies whose mothers have chorioamnionitis will undergo intravenous antibiotic treatment even if they show no symptoms at all. The treatment is shortened if the tests yield negative results. But if your baby has pathogens in his samples, he may undergo antibiotic treatment for up to 3 weeks.
Sepsis is a potentially life-threatening medical condition, especially in newborn babies. Fortunately, this condition is highly treatable once it is detected earlier. So, we always encourage routine screening for pregnant women. Your healthcare provider will tell you the safest thing to do if you contracted the infection while pregnant.
Hospital care and antibiotic treatments decrease the mortality risk in newborn babies. Proper medical care will give your baby the highest chance of survival. Sepsis does not pose long-term problems in babies who survived it. And as for my friend, she now lives happily with her school-age kid with their inspiring battle story to tell.
Ann Marie is a licensed nurse in the Philippines. She had experiences in handling and assisting deliveries of newborns into the world. She also used to train in labor rooms and pediatric wards – helping soon-to-be mothers and little kids in the process. Though not a mother by nature but a mother by heart, Ann Marie loves to take care of her younger cousins as well as nephews and nieces during her free time.