Infections in the NICU: Neonatal Sepsis

Neonatal infections remain a substantial cause of infant morbidity and mortality worldwide, particularly in the very-low-birthweight (VLBW) preterm infant population.1,2 Common neonatal infections can be classified according to how they are acquired: in utero, intrapartum, and postpartum. In utero infections are due to maternal infection and may occur any time before delivery. Intrapartum infections are attributed to ascending infections, which can result in preterm rupture of membranes. These ascending infections can also present following a delayed delivery after rupture of membranes. Postpartum infections are thought to be due to contact with the neonate's environment, including maternal contact, breastfeeding, or nosocomial infections such as central-line-associated blood stream infections (CLABSI) and ventilator-associated pneumonia (VAP).2,3

Neonatal sepsis is a systemic neonatal infection of bacterial, viral, or fungal origin that is associated with various clinical manifestations and hemodynamic changes.4 Neonatal sepsis is divided into early and late onset sepsis based on timing of onset and therein mode of acquisition. Whereas recent changes in maternal screening practices and intrapartum antibiotic administration has decreased the incidence of neonatal sepsis, it remains a significant cause of neonatal morbidity and mortality in the United States.5,6 Sepsis continues to affect 4 to 22 newborns per 1000 live births globally, with the frequency varying inversely with gestational age at birth.7 Neonatal sepsis case fatality rates have been shown to be 2% in term infants, 20% in premature infants, and 30% in those infants diagnosed with concomitant meningitis.8 Long-term clinical consequences for infants that survive neonatal sepsis are significant, and include various forms of neurodevelopmental delay.9 This chapter will focus on both early and late onset neonatal sepsis, and discuss their differing pathophysiology, difficulties in diagnosis and identification of infants at risk for sepsis, as well as medical management.

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