Neonatal infection

definition

A newborn infection is when a newborn child is infected with an infectious disease up to the 4th week of life. Colloquially, however, it is often used to describe infectious diseases in infants up to the age of one. Strictly speaking, however, newborns are children who have not reached the 4th week of life.

Infections in newborns can be caused by various pathogens. Most of them are bacterial infections caused by group B streptococci or Staphylococci. Sometimes, however, gram-negative pathogens (also bacteria) are the cause of the infection.
The newborn infection should not be confused with other infectious diseases that can, for example, be transmitted from the mother to the child during pregnancy or childbirth. This would include, for example. HIV or CMV counting. However, these are by definition no newborn infections.

One distinguishes the systemic Neonatal infection called neonatal sepsis from topical (local) neonatal infections.

Frequency of neonatal infections

It is difficult to come up with an exact number when it comes to neonatal infection / sepsis. One can approximately from 1 to 2 cases per 1000 births go out. Some figures speak of 0.29 cases per 1,000 births.

It must be taken into account that often only those cases of newborn infections are counted for which group B streptococci are the cause and which could also be isolated as pathogens. However, it can be assumed that the value is between 1 and approx. 0.3 per 1000 live births.

It is noticeable, however, that the lower the birth weight is the more often babies are affected by newborn sepsis. If the birth weight is less than 1.5kg, newborn sepsis occurs in up to 15% of babies. This also speaks for a high relevance in premature babies.

There are also various risk factors that can further increase the likelihood and frequency of a newborn infection. This includes a Amniotic Infection Syndrome or blood poisoning in the mother and a birth well before the calculated date. In children, risk factors include all kinds of possible entry points such as wounds or accesses.

As a result of the prophylaxis against group B streptococci, the frequency of neonatal sepsis has decreased significantly. The Lethality (Mortality) of neonatal sepsis is also declining due to good therapeutic measures, but is still present in mature newborns 4%. Premature babies are at greater risk of dying.

Symptoms

Symptoms typical of the mother are typical symptoms of amniotic infection syndrome, which can lead to infection of the newborn. There is a fever and premature rupture of the bladder with foul-smelling amniotic fluid.

If the newborn suffers an infection, general symptoms tend to be unspecific and for which no real trigger can be found. The baby seems listless (apathetic) or even clouded consciousness (lethargic), drinks only badly and keeps getting excited. It also often shows a change in skin color. This ranges from pale to yellowish to greenish. The baby's breathing difficulties are very stressful for the parents. Some babies exhibit considerable breathing effort with moaning, also called that Creak referred to as, Nostrils or indentations between the ribs. In some newborns there are even pauses in breathing, which then make it necessary to monitor the oxygen saturation. In the course of the newborn infection, circulatory problems can also occur. The blood increasingly collects in the center of the body. As a result, there is low arterial blood pressure and a very fast heartbeat (Tachycardia).

Another term for neonatal infection is Neonatal sepsiswhich in turn would mean that bacteria can potentially damage any organ in the sense of blood poisoning.
So it can e.g. pneumonia in the newborn and, in the worst case, meningitis. This Neonatal meningitis presents itself in the early phase through increasing clouding of consciousness, reduced drinking behavior and breathing difficulties. In the late phase, the fontanel bulges and the baby screams shrilly. This can also cause seizures.

Please also read our topic: Blood poisoning in the child

causes

First of all, it is important between the systemic Neonatal infection (Neonatal sepsis) and the topical To differentiate between newborn infections, since different causes and therapeutic consequences as well as consequences result for both clinical pictures.

Early onset sepsis

There are two different forms of sepsis in the newborn. One speaks of so-called early-onset sepsis or early-onset infection if it occurs within the first 72 hours of the newborn's life.

The most common culprit is the germ Streptococcus agalactiae, closely followed by E. coli Bacteria. Are rarer Listeria and Staphylococci the cause. The germs mostly come from the mother's vaginal flora and are usually transmitted to the child as part of an amniotic infection before birth. The pathogens get from the rectum and vagina of the mother into the birth canal and the uterus, where they cause inflammation of the membranes. As a result, the pathogens get into the amniotic fluid that surrounds the fetus. This mechanism means that the unborn child comes into contact with the pathogens and these aspirated. The result is then one Pneumonia in the baby.
However, the pathogen can also be transmitted to the newborn during birth.

Late-onset sepsis

Late sepsis or late-onset sepsis / infection is characterized by the onset of the disease 72 hours after birth occurs. This late sepsis can still occur in the hospital or manifest if the parents have already taken the child home with them.

The mechanism by which it develops is mostly the same as in early-onset sepsis. Here, too, it is pathogens that are transmitted from mother to child during birth and thus trigger the infection. The immune system of the newborn is only able to contain the infection for a little longer, so that it only shows up a little later. Here, too, the process can rapidly deteriorate over a period of a few hours.

These two forms of infection must be strictly distinguished nosocomial infection, in which germs are transmitted to the child during the hospital stay, e.g. through lying venous access or through intubation. Sometimes the nosocomial infection is also referred to as late-onset sepsis.
There are common risk factors that make sepsis more likely to develop in the newborn. Both forms of sepsis are increased in premature babies (before the 37th week of pregnancy) and newborns with a low birth weight.

The late sepsis is also favored by measures such as artificial feeding via a gastric tube or lying venous access. In early sepsis, the mother's ammnion infection syndrome is a very large risk factor. Should be with the mother in vaginal smear Group B streptococci detected or an increase in bacteria in the urine (Bacteriuria) have been found, the risk of early-onset sepsis in the newborn is also greatly increased.

Streptococcal infection

Streptococci are gram-positive pathogens that can cause a wide variety of diseases. They play a key role in the development of newborn infections. So-called Group B streptococci are the most common pathogen neonatal sepsis. This is specifically the pathogen Streptococcus agalactiae, which is usually transmitted to the child by the mother. This can happen during or before the birth.

This is particularly feared Amniotic Infection Syndrome the mother, which is caused in particular by streptococcus agalactiae (but also staphylococci, enterococci, etc.). This infection carries a high risk for one at times life threatening sepsis of the baby but also of the mother and must in any case treated with antibiotics become.
Signs of such maternal ammnion infection syndrome due to streptococci are high fever the mother (> 38 °), a foul-smelling amniotic fluid discharge, a tender uterus and premature labor as well as premature rupture of the bladder.
The examination results show an increased CRP (C-reactive protein) and an increased BSG (Sedimentation rate) the mother as well as one Leukocytosis (high level of white blood cells). These three parameters represent classic inflammation values. In children, tachycardia (> 100 heartbeats per minute) can be noticed even before birth.

Infection of the newborn through the amniotic fluid

The Pathogen a newborn infection can stransmitted to the child through the amniotic fluid before birth become. This usually occurs within the first three days of life and is therefore also called early neonatal infection (early-onset sepsis) designated. The group is one of the most common pathogens B streptococci (Streptococcus agalactiae), E. coli, Listeria, Klebsiella and the Staphylococcus aureus. These bacteria mostly come via the rectum into the vagina. The bacteria then ascend through the vaginal flora into the birth canal and into the uterus. This can also lead to a Amniotic Infection Syndrome in which in addition to the membranes also the amniotic fluid and the unborn child. As a result of the Amniotic Infection Syndrome In turn, a newborn infection can develop.

Newborn infection after a caesarean section

A Caesarean section prevents infection of the newborn as it passes through the vagina. A newborn infection can be done with it but not completely prevent it. In some cases, an infection occurs before the birth or just afterwards.

In late newborn infection (Late-onset sepsis) germs are transmitted either during birth and only break out later or after birth with germs during the stay in hospital (nosocomial). Correspondingly, the symptoms appear later than in early neonatal infections. The spectrum of germs is also different.

Since a caesarean section is a surgical procedure, surgical complications can arise here. Therefore should always be weighed up with the specialistwhich type of birth is safest individually.

Umbilical infection

The umbilical infection (Omphalitis) is a local infection in newborns. Typically, the pathogens, which are mostly streptococci or staphylococci, are transmitted to the child by the mother, causing a bacterial inflammation of the navel.
This infection is also promoted by too infrequent diaper changes and poor hygiene.

Read more on this topic at: Inflammation of the belly button in the baby

Consequences of a newborn infection

The consequences of a newborn infection can very serious be. She needs one immediate therapyin which no time should be lost.

It is the Neonatal sepsis a systemic infection, i.e. affecting the whole body and the blood system, which can sometimes be fatal for a newborn. Since the children do not yet have a fully developed immune system, can no spontaneous healing without medical measures respectively. In the course of the infection, the children sometimes show very unspecific symptoms such as apathy, circulatory disorders with a rapid heartbeat (Tachycardia), Breathing problems and a change in skin color (from pink to green-yellow). In principle, any organ can be affected by sepsis, so that, for example, the urinary tract or the ear with a severe one Otitis media in the baby may be affected.

However, they are particularly dangerous Neonatal meningitis (Meningitis) and the Neonatal pneumonia (Pneumonia) that may be caused by sepsis. The inflammation of the meninges can manifest itself as high-pitched screaming, poor drinking, lethargy and a bulging fontanel. Neonatal pneumonia makes it difficult for the child to breathe and leads to rapid breathing (Tachypnea) and nostrils.
Read our articles on this Meningitis in the baby and Pneumonia in the baby

The forecast is with one early treatment of the children Well. Nevertheless, long-term damage can persist in the event of a severe course or late therapy. Permanent neurological damage or high blood pressure in the pulmonary vessels can occur.

How dangerous is a newborn infection?

Newborn sepsis is a case for them Intensive care unit. It is a highly acute clinical picture and in any case represents one emergency The therapy must be started immediately in order to avoid consequential damage.

The longer the newborn infection persists, the more organs are involved and the higher the risk of it spreading to the brain. In the worst case, the newborn infection escalates into you septic shock. At the end of the spetic shock, there is circulatory failure. There is an acute one Kidney and Lung failure up to multiple organ failure, so that neonatal sepsis without therapy can be fatal within a few hours or days.

However, the earlier therapy is started, the better the children's prognosis. With good prophylaxis and a rapid antibiotic therapy Only about 4% of children die of one Neonatal sepsis.

Is a Newborn Infection Contagious?

A newborn infection is not contagious to the environment. The transmission route runs through the amniotic fluid, the birth canal or nosocomial, i.e. in connection with the hospital stay, mostly due to insufficient hand hygiene in the hospital. The newborn is then in contrast to the healthy environment due to an inadequate Immune protection endangered.

Treatment of Newborn Infection

Therapy for newborn infection initially includes one intensive medical care. The children's circulation can be improved with infusions and circulation-stabilizing drugs (Catecholamines) are stabilized. The stabilization of the coagulation system, the electrolytes, the bloodpH value as well as blood sugar is also part of the treatment.

It is also important to secure the airways in the event of insufficient breathing and to ensure an adequate supply of oxygen. Immediate therapy with Antibiotics to be started. This is initiated before the pathogen is identified. This is very important as there is no time to waste. It becomes a so-called Broad spectrum antibiosis administered.

Antibiotics for a newborn infection

The gift of Antibiotics is the only way to cure and defeat a newborn infection. Therapy begins as early as possible without a confirmed diagnosis and gives a so-called Broad spectrum antibiosis. This is a combination of several antibiotics that should cover and fight as many germs as possible. Clinical suspicion is enough to start therapy.

At a Early onset sepsis comes a combination 3rd generation cephalosporins, Aminoglycosides and Ampicillin for use. If the condition worsens, the administration of Metronidazole be considered. This antibiotic covers the so-called anaerobes. These are germs that are actually not typical of newborn sepsis, but which must be taken into account if the usual therapy does not work.
The exact choice of antibiotic also depends on the age of the newborn.

At a Late sepsis one expects somewhat different pathogens. Therefore one then typically combines one 3rd generation cephalosporins with a Aminoglycoside or a cephalosporin with Vancomycin. Also Carbapenems are used.
A triple combination or a against fungi effective drug can also be considered. That depends on the clinical condition of the child.
At a Meningitis one combines e.g. Vancomycin with a Cephalosporin 3rd generation and an aminoglycoside.

If a pathogen can be isolated through diagnostic measures, the antibiotic therapy is then specially adapted to the pathogen. The Duration of therapy depends on the clinical findings and the condition of the newborn. If the diagnosis is normal, the therapy is ended after 2 days. However, if the diagnosis has been confirmed by means of diagnostic measures, therapy is carried out for at least 5 to 7 days (without evidence of pathogens). If a pathogen has been detected in the blood culture, therapy is carried out for at least 7 days. In the case of meningitis, antibiotic therapy lasts for at least 10 days.

Duration

The duration of a newborn infection varies. At the beginning there is clinical suspicion. Inpatient monitoring is carried out, in some cases even in the intensive care unit. The focus is on the stabilization of the circulatory system and the broadest possible elimination of possible pathogens. The total duration is then depending on the further development. If the monitoring and diagnostics are normal, the disease is usually over within a few days. If there are abnormalities in the laboratory and a pathogen is detected, the course can take up to 10 days or longer.