Sepsis in Newborns

Overview

What is sepsis in newborns?

Sepsis in newborns (neonatal sepsis) is a serious medical condition that affects babies younger than 28 days old. Sepsis occurs when your body has an extreme response to an infection. A newborn who has an infection and develops sepsis can have inflammation throughout their body. This inflammation and blood clotting causes reduced blood flow to your baby’s limbs and vital organs. It can lead to organ failure and even death.

Healthcare providers classify neonatal sepsis into two categories based on the age of onset:

  • Early-onset neonatal sepsis: Most providers use the term “early-onset neonatal sepsis” to describe sepsis that develops within the first 72 hours of life.
  • Late-onset neonatal sepsis: Most providers refer to “late-onset neonatal sepsis” as sepsis that develops after three days of life.

Who does neonatal sepsis affect?

Neonatal sepsis can affect any baby. But premature babies develop sepsis more often than full-term babies because their immune systems are immature. Babies born prematurely don’t have antibodies to protect them against certain bacteria. That’s because they’re born before they can receive the antibodies from their birthing parent. Neonatal sepsis also more commonly occurs in babies who:

  • Have a low birth weight.
  • Have a low Apgar score.
  • Are assigned male at birth.
  • Have a birthing parent with certain risk factors, such as an infection during pregnancy.

How common is this condition?

More than 75,000 babies and children develop severe sepsis in the United States every year.

Symptoms and Causes

What are the signs of sepsis in a newborn?

Many of the symptoms of sepsis in newborns are ones you’ll see when your baby is sick with another illness. More often than not, your baby won’t have sepsis. But if your newborn has more than one of these symptoms or they seem sicker than normal, you should seek medical care right away. Neonatal sepsis symptoms may include:

  • Fever or low temperature.
  • Fast or slow heart rate.
  • Fast breathing or shortness of breath.
  • Vomiting.
  • Diarrhea.
  • Reduced sucking/difficulty feeding.
  • Swollen belly (abdomen).
  • Cold hands and feet.
  • Clammy, pale skin.
  • Yellow skin and whites of their eyes (jaundice).
  • Reduced activity.
  • Seizures.

What is the leading cause of neonatal sepsis?

Bacterial infections are the most common cause of sepsis in newborns. Bacteria such as E. coli, Listeria and Group B streptococcus (GBS) are common bacteria that can cause infections that lead to sepsis.

Viruses, fungi and parasites can also lead to the condition. For instance, the herpes simplex virus (HSV) can cause severe infections in newborns.

How do newborns get sepsis?

Newborns develop sepsis in different ways based on their age of onset.

Early-onset neonatal sepsis

Newborns with early-onset neonatal sepsis get an infection from their birthing parent before or during delivery. These infections occur when your baby is exposed to certain types of bacteria. These infections happen more often when:

  • Bacteria such as GBS have colonized in your vagina during pregnancy.
  • Your baby is born prematurely.
  • Your water breaks early (more than 18 hours before your baby is born).
  • There’s an infection in the placenta and amniotic fluid (a condition known as chorioamnionitis).

Late-onset neonatal sepsis

Newborns with late-onset neonatal sepsis get an infection after delivery. Your baby can acquire an infection from bacteria in their new environment, rather than bacteria from your body. Bacteria can spread to your newborn through medical equipment such as catheters, IVs and tubes. These infections happen more often when your baby:

  • Has a low birth weight.
  • Needs a breathing tube.
  • Needs antibiotics.
  • Has a catheter inserted in a blood vessel or their bladder for a long time.
  • Needs treatment for another condition that prolongs their stay at the hospital.

Diagnosis and Tests

How is sepsis in newborns diagnosed?

Healthcare providers use specific guidelines to diagnose neonatal sepsis. They’ll evaluate your baby’s symptoms and ask about your medical history.

You may hear your baby’s provider use the term “sepsis work-up.” A sepsis work-up refers to the tests they’ll use to diagnose the cause of your baby’s infection. The sepsis work-up may include:

  • Blood tests: Complete blood count, blood cultures and C-reactive protein.
  • Urine tests: Urinalysis and urine culture.
  • Spinal tap (lumbar puncture): A provider inserts a very small needle into the space around your baby’s spine to withdraw spinal fluid to test for infections.
  • Imaging tests: Chest X-ray or ultrasound.

Management and Treatment

How do you treat sepsis in newborns?

Neonatal sepsis treatment needs to begin immediately. Your baby’s healthcare provider may admit your baby to an intensive care unit (ICU). Treatment for sepsis in newborns may include:

  • Intravenous (IV) fluids.
  • IV antibiotics to fight bacterial infections.
  • Antiviral medication to fight viral infections.
  • Heart and/or blood pressure medications.
  • Extra oxygen and other forms of respiratory support, if needed.

Occasionally, babies may need blood transfusions.

Prevention

How can I prevent neonatal sepsis?

To prevent passing along an infection to your baby, your obstetrician may recommend you take preventive antibiotics. Your provider will give you IV antibiotics for several hours before delivery if:

  • You have an infection such as chorioamnionitis.
  • You have group B strep colonization in your vagina.
  • You’ve had a previous baby born with sepsis.

In addition, there are steps you can take to prevent sepsis, including:

  • Practice good hygiene.
  • See your healthcare provider regularly.
  • Get your recommended vaccines.
  • Know the signs of sepsis.
  • Get care fast if you think you or your baby have sepsis.

Outlook / Prognosis

Is sepsis curable in newborns?

Sepsis in newborns is curable. Many newborns who develop sepsis recover completely and don’t have any other issues.

But neonatal sepsis is one of the leading causes of infant death. The quicker your baby gets treatment, the better their outcome will be. The risk of death from sepsis increases by about 7.6% with every hour that passes without treatment.

What are the possible complications of neonatal sepsis?

Most newborns who recover from sepsis don’t develop any complications. But many babies who survive develop long-term health issues. More than one-third of babies who survive sepsis will experience a delay in cognitive skills. Almost half of neonatal sepsis survivors return to the hospital at least once after recovery.

Some babies develop an infection of the membranes surrounding their brain called meningitis. Newborns who have this condition may develop serious symptoms and side effects, including:

  • Extreme sluggishness (lethargy).
  • Bulging of the soft spot between their skull bones (fontanelle).
  • Hearing loss.
  • Developmental delays.
  • Cerebral palsy.
  • Seizures.
  • Coma.

Living With

When should I take my newborn to the ER?

If you’re home from the hospital and your newborn develops the following symptoms of sepsis, call 911 or go to the nearest emergency room:

  • Your baby is unusually irritable or sleepier than normal.
  • Your baby’s skin is cold, pale or discolored.
  • Your baby has had dry diapers for more than 12 hours.
  • Your baby is unresponsive or having trouble breathing.

When should I follow up with my newborn’s healthcare provider?

When your baby’s pediatrician discharges them from the hospital, they’ll want to see them within two to three days. Make an appointment to come back in for your baby’s provider to check for continued signs of recovery.

Frequently Asked Questions

What’s the sepsis risk calculator?

The Kaiser neonatal sepsis calculator, or early-onset sepsis calculator, is a tool healthcare providers use to determine your newborn’s risk of developing early-onset neonatal sepsis. The tool estimates your baby’s chances of getting the condition based on multiple variables, including your risk factors and your baby’s condition at birth.

A note from Cleveland Clinic

There are many things you may worry about when you have a newborn. Neonatal sepsis probably wasn’t one of them. But if you think your newborn may have this life-threatening condition, seek treatment right away. Neonatal sepsis is a medical emergency. The faster you get medical care for your infant, the better their outcome will be.

Last reviewed by a Cleveland Clinic medical professional on 01/21/2023.

References

  • Merck Manual. Sepsis in Newborns. (https://www.merckmanuals.com/home/children-s-health-issues/infections-in-newborns/sepsis-in-newborns) Accessed 1/23/2023.
  • Puopolo KM, Benitz WE, Zaoutis TE; COMMITTEE ON FETUS AND NEWBORN; COMMITTEE ON INFECTIOUS DISEASES. Management of Neonates Born at ≥35 0/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. (https://pubmed.ncbi.nlm.nih.gov/30455342/) Pediatrics. 2018 Dec;142(6):e20182894. Accessed 1/23/2023.
  • Sepsis Alliance. Sepsis and Children. (https://www.sepsis.org/sepsisand/children/) Accessed 1/23/2023.
  • Singh M, Alsaleem M, Gray CP. Neonatal Sepsis. (https://www.ncbi.nlm.nih.gov/books/NBK531478/) [Updated 2022 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 1/23/2023.

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