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Neonatal sepsis

Sepsis neonatorum · Novorozenecká sepse

What it is

Bloodstream infection in the first four weeks — early-onset from the mother's birth canal (group B streptococcus, E. coli), late-onset from hospital or home; one of the three leading causes of newborn death worldwide.

Symptoms & signs

  • Poor feeding and lethargy
  • temperature too high or too low
  • grunting, fast breathing or pauses in breathing
  • mottled or grey skin, slow capillary refill
  • jaundice or low blood sugar
  • bulging fontanelle and seizures if meningitis

🚩 Get help if…

  • call 112 / 911 now Temperature 38 °C or more, or under 36 °C, in a baby under 3 months
  • call 112 / 911 now Floppy, hard to wake, or a weak high-pitched cry
  • call 112 / 911 now Grunting, fast breathing or pauses in breathing
  • call 112 / 911 now Pale, blue or blotchy skin, or a rash that does not fade

Where it strikes

Medical treatment

  • Blood culture, then IV antibiotics within the hour (benzylpenicillin or ampicillin with gentamicin; cefotaxime if meningitis)
  • lumbar puncture when meningitis is possible
  • stop antibiotics at 36–48 hours if cultures are negative and the baby is well
  • Antibiotics in labour for mothers carrying group B streptococcus or with risk factors — early-onset GBS disease fell by over 80% in the US (observational) trials support
  • breathing, circulation and glucose support

Natural & lifestyle

  • Exclusive breastfeeding — fewer infections trials support
  • Kangaroo skin-to-skin care for small babies — fewer deaths and infections trials support
  • clean birth, clean hands, clean cord
  • Chlorhexidine on the cord for home births — fewer deaths in South Asia, not in Africa mixed evidence

Emerging & experimental

  • Maternal group B streptococcus vaccine — in trials
  • IV immunoglobulin — INIS trial: no benefit not confirmed in trials
  • Risk calculators (Kaiser) to spare well babies antibiotics

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Lactoferrin for preterm babies — ELFIN trial: no fewer late-onset infections not confirmed in trials
  • Colostrum dripped into the mouth of preterm babies — small trials; unclear effect on infection early / small studies

ICD codes