OVERVIEW

What is neonatal sepsis?

Sepsis refers to a bacterial infection in the blood.

Neonatal sepsis is a severe disease caused by infection that leads to systemic symptoms in newborns. A defining feature of sepsis is the identification of pathogens through blood culture. During the illness, pathogens multiply in the child's body and spread through the bloodstream to various organs, causing organ failure. In the early stages, the disease lacks distinctive symptoms, and some manifestations are mild, making it difficult to detect.

Sepsis poses a life-threatening risk to newborns, accounting for 15% of global neonatal deaths. It is a serious condition requiring aggressive treatment, and with timely and appropriate use of antibiotics, neonatal sepsis can be cured.

Is neonatal sepsis common?

It is not rare, occurring in approximately 1 to 5 out of every 1,000 newborns. Premature infants are more susceptible to sepsis.

What are the types of neonatal sepsis?

Neonatal sepsis can be classified into early-onset sepsis and late-onset sepsis. Early-onset sepsis occurs within the first few days after birth, while late-onset sepsis occurs after 7 days of life.

• Risk factors for early-onset sepsis include:
• Premature rupture of membranes in preterm infants;
• Maternal infection;
• Presence of Group B Streptococcus (GBS) in the mother.

If the amniotic membrane ruptures more than 18 hours before delivery or if the mother has an infectious disease (especially urinary tract infection or endometritis), the risk of sepsis increases significantly.

• Key risk factors for late-onset sepsis include:
• Long-term use of arterial or venous catheters;
• Endotracheal intubation in the nose or mouth, requiring mechanical ventilation;
• Prolonged hospitalization.

Late-onset sepsis often arises from unclean hands or environments and can be caused by various microorganisms.

SYMPTOMS

What are the symptoms of neonatal sepsis?

There are no characteristic symptoms. Some manifestations are mild and difficult to detect. The main symptoms include:

• Fever or low body temperature;
• Refusal to eat or reduced milk intake;
• Increased crying, irritability, or drowsiness;
• Rapid breathing or cyanosis (bluish skin);
• Cold limbs;
• Jaundice;
• Vomiting;
• Diarrhea.

What are the complications of neonatal sepsis?

Respiratory failure, neonatal meningitis, acidosis, pneumonia, septic shock, and other conditions. The more complications present, the more severe the condition. Poorly treated sepsis can lead to serious consequences, including death.

CAUSES

What are the common causes of neonatal sepsis?

Neonatal sepsis is primarily caused by pathogens entering the baby's body and causing infection. It is mainly caused by bacteria, including common strains such as Escherichia coli, Group B Streptococcus, Listeria, and Staphylococcus aureus. In some special cases, viruses and fungi may also lead to sepsis.

Which babies are more susceptible to neonatal sepsis?

• Premature babies with a gestational age of less than 37 weeks.
• Babies whose mothers had a fever before birth or required antibiotic treatment for an infection.
• Babies with premature rupture of membranes (PROM). The symptom of PROM is the mother's amniotic fluid leaking before labor begins. The longer the rupture persists, the higher the risk of sepsis.
• Mothers with Group B Streptococcus (GBS) infection or a history of delivering a baby with GBS-related sepsis.
• Babies who experienced asphyxia or had meconium-stained amniotic fluid.

When is neonatal sepsis most likely to occur?

Due to the weak immune barrier function of newborns, sepsis can occur both shortly after birth or more than 7 days after delivery.

DIAGNOSIS

What tests are needed for neonatal sepsis?

Blood tests including complete blood count, blood culture, and PCT; chest X-ray; lumbar puncture; sputum culture and urine culture are required.

Why are these tests performed for neonatal sepsis?

• Complete blood count and PCT: Help determine whether there is a bacterial infection.
• Blood culture, sputum culture, urine culture, and cerebrospinal fluid culture: Identify the infectious pathogen and the site of infection.
• Lumbar puncture: Obtain cerebrospinal fluid samples for testing, which is an essential examination for diagnosing this condition. Cerebrospinal fluid circulates through the spinal canal and brain, similar to tears and gastric fluid, and is regenerated daily. Collecting samples from the lumbar region avoids brain damage while allowing cerebrospinal fluid to be obtained for assessing potential brain infections.

Is a lumbar puncture mandatory for infants with neonatal sepsis?

Lumbar puncture is a routine examination for neonatal sepsis.

The procedure is performed by experienced doctors after obtaining written parental consent. Due to the small size of newborns, specialized small needles—similar to those used for blood tests in adults—are used.

Adverse reactions from lumbar puncture are rare, and the procedure itself does not cause significant harm or long-term effects. However, delaying the diagnosis and treatment of meningitis or encephalitis by avoiding lumbar puncture may lead to neurological complications.

Therefore, parents should not fear this examination. Instead, they should communicate with the attending physician and, if necessary, actively complete the tests to aid in treatment.

TREATMENT

Which department should be consulted for neonatal sepsis?

Neonatology Department, Neonatal Intensive Care Unit (NICU).

How is neonatal sepsis treated?

Comprehensive treatment in the neonatal ward is required. The key is infection control, with early, timely, and adequate antibiotic therapy being crucial. Simultaneously, the extent of organ damage must be assessed, and comprehensive supportive care should be provided.

What should be noted during hospitalization for neonatal sepsis?

In non-accompanied wards, mothers should maintain breast milk production. Regular pumping is advised, and the milk can be stored in breast milk storage bags and frozen. This ensures the baby has access to breast milk after discharge, which greatly benefits their long-term health. The immune components in breast milk protect the baby and reduce infection risks, while the act of breastfeeding helps establish a strong mother-child bond. Some NICUs allow donated breast milk—if possible, this is even better.

In accompanied wards, mothers can continue direct breastfeeding while cooperating with medical treatment.

Is follow-up required after discharge for neonatal sepsis?

Yes, follow-up is necessary. After recovery, the primary focus is assessing whether other organs have been affected. Follow-ups should be scheduled as advised at discharge. Typically, only physical examinations are needed to evaluate the baby's condition. Blood tests or imaging may be considered only if necessary.

Can neonatal sepsis recur?

Recurrence is unlikely. Once cured, sepsis does not typically recur. However, preterm infants with immature immune systems may, in rare cases, develop sepsis again due to different pathogens—though this possibility is small.

Does neonatal sepsis leave long-term complications?

Neonatal sepsis itself does not cause long-term complications after recovery. However, if other complications (e.g., purulent meningitis) occur, they may lead to sequelae.

DIET & LIFESTYLE

What should be paid attention to in the diet of neonatal sepsis?

Breastfeeding is preferred for newborns. The immune substances in breast milk can protect the baby and reduce the risk of infection. Infant formula should only be used when breast milk is unavailable.

What should be paid attention to in the daily life of neonatal sepsis?

After returning home, parents should have more skin-to-skin contact with the baby, such as gentle massages, as physical closeness benefits the baby's development. Maintaining eye contact and talking to the baby helps build a stronger parent-child bond and promotes nervous system development.

Ensure proper room ventilation and wash hands frequently.

PREVENTION

Can Neonatal Sepsis Be Prevented?

Certain measures can reduce the risk of neonatal sepsis, including:

• Regular prenatal checkups during pregnancy. Seek medical attention promptly if abnormalities such as fever, reduced fetal movement, or premature rupture of membranes occur in the third trimester.
• If the mother has an infection in the third trimester, do not refuse antibiotics out of fear—actively cooperate with the doctor for treatment.
• Deliver the baby in a hospital. If delivery occurs at home or en route, do not cut the umbilical cord yourself.
• For premature infants, follow medical treatment in the hospital.
• Avoid folk remedies like needle pricks or burning treatments for newborns—any procedure that may break the skin must be performed in a hospital.
• Regularly disinfect the umbilical cord stump.
• Limit close contact between newborns and visitors, and avoid contact with sick individuals.
• Maintain breastfeeding for at least one year to reduce the baby’s likelihood of illness.
• Seek medical help promptly if the newborn shows concerning symptoms.