Sepsis in neonates

6 Interesting Facts of Sepsis in neonates

  1. Congenital pneumonia is a serious infection that frequently results in stillbirth or death in the first 24 hours after birth. Presents with signs of respiratory distress mimicking meconium aspiration syndrome in the first few hours after birth 
  2. Chest radiograph findings are variable depending on cause (eg, lobar consolidation or bilateral consolidation); blood and tracheal aspirate cultures can isolate bacterial, fungal, and viral causes 
  3. Congenital infections causing respiratory distress associated with chest radiograph findings are very difficult to distinguish from meconium aspiration syndrome; as a result, many infants in whom meconium aspiration syndrome is eventually diagnosed are started on antibiotics pending culture results in an effort to exclude infectious processes
  4. Early-onset neonatal sepsis with pneumonia (within the first 7 days after birth) most often presents with systemic disease (eg, temperature instability, respiratory distress, apnea, jaundice, lethargy) after a relatively benign immediate postnatal course; mothers may have risk factors for early-onset sepsis 
  5. Symptoms usually take hours to days to develop and are not immediately apparent (as they usually would be in meconium aspiration syndrome) 
  6. Differentiate from meconium aspiration syndrome by history, clinical course (characterized by absence of symptoms immediately after birth and improvement with antibiotic treatment), and positive blood culture results or tracheal aspirates

Presents similarly in neonates and infants, with nonspecific manifestations such as tachypnea, respiratory distress, tachycardia, poor perfusion, lethargy, fussiness, and poor feeding; cardiac and other organ dysfunction may develop

Sepsis may be more likely to result in temperature instability and abnormally high or low WBC indices than myocarditis; however, depending on underlying cause, fever may be a manifestation of myocarditis

Diagnoses are difficult to differentiate on clinical grounds alone; ancillary studies (eg, echocardiogram, cultures) are often required to aid in differentiation

Diagnose sepsis with blood cultures and clinical course (eg, response to empiric antibiotics)


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