The vast majority of newborns enter the world healthy. But
sometimes, infants develop conditions that require medical tests
and treatment.
Newborns are particularly susceptible to certain diseases, much
more so than older children and adults. Their new immune systems
aren't adequately developed to fight the bacteria, viruses, and
parasites that cause these infections.
As a result, when newborns get sick, they may need to spend time
in the hospital - or even the neonatal intensive care unit (NICU) -
to recover. Although it can be frightening to see your baby
hospitalized, a hospital stay is often the best way back to good
health for a sick newborn.
Signs to Look for
Many infections cause similar symptoms. Call your child's
doctor or seek emergency medical care if your new baby shows any of
these possible signs of infection:
- poor feeding
- breathing difficulty
- listlessness
- decreased or elevated temperature
- unusual skin rash or change in skin color
- persistent crying
- unusual irritability
A marked change in a baby's behavior, such as suddenly
sleeping all the time or not sleeping much at all, can also be an
indication that something isn't right.
These signs are of even greater concern if the baby is less than
2 months old. To make ensure good health, have your baby checked by
a doctor right away if you suspect a problem.
Group B Streptococcal Disease (GBS)
What is it?
Group B
streptococcus
is a common type of bacterium that can cause a variety of
infections in newborns. Some of the most common are sepsis,
pneumonia, and meningitis. Babies usually get the bacteria from
their mothers during birth - many pregnant women carry these
bacteria in the rectum or vagina, where they can easily pass to the
newborn if the mother hasn't been treated with antibiotics.
Babies with GBS often show symptoms of infection within the
first week of life, although some develop symptoms weeks or months
later. Depending on the infection (pneumonia or sepsis, for
example), the symptoms might include trouble breathing or feeding,
a high temperature, listlessness, or unusual crankiness.
How is it diagnosed and treated?
To diagnose GBS, doctors run blood tests and take cultures of
blood, urine, and, if necessary, cerebrospinal fluid to look for
bacteria. Doctors use needles to obtain a blood sample and a spinal
needle to do a lumbar puncture for the cerebrospinal fluid. The
urine is usually obtained by a catheter inserted into the urethra.
Infections caused by GBS are treated with antibiotics, as well as
careful care and monitoring in the hospital.
Listeriosis
What is it?
Infection with
Listeria monocytogenes
bacteria can lead to diseases such as pneumonia, sepsis, and
meningitis in newborns. Most people encounter the bacteria by
eating contaminated food because the bacteria are found in soil and
water and can end up on fruits and vegetables, as well as in foods
that come from animals, such as meat and dairy products. Food that
isn't properly cleaned, pasteurized, or cooked may give someone
listeriosis
.
Babies can acquire bacteria from their mothers if the mother
contracts listeriosis while pregnant. In severe cases, listeriosis
may lead to premature delivery or even stillbirth. Babies born with
listeriosis may show signs of infection similar to those of
GBS.
How is it diagnosed and treated?
A blood or spinal fluid culture can reveal the presence of the
bacteria, and infected babies will be treated with antibiotics in
the hospital.
E. Coli
Infection
What is it?
Escherichia coli (E. coli)
is another bacterial culprit behind some common neonatal
infections, and can lead to urinary tract infections, sepsis,
meningitis, and pneumonia. Everyone carries
E. coli
in their bodies, and babies can become infected during childbirth,
when they pass through the birth canal, or by coming into contact
with the bacteria in the hospital or at home. Most newborns who
become ill from
E. coli
infection have particularly fragile immune systems that make them
particularly vulnerable to getting sick.
As with other bacterial infections, the symptoms will depend on
the kind of infection that develops from
E. coli
, but fever, unusual fussiness, listlessness, or lack of interest
in feeding are common.
How is it diagnosed and treated?
Doctors diagnose
E. coli
infection by culturing blood, urine, or cerebrospinal fluid and
treat the infection with antibiotics.
Meningitis
What is it?
Meningitis is an inflammation of the membranes surrounding the
brain and spinal cord. It can be caused by viruses, fungi, and
bacteria, including
Listeria
, GBS, and
E. coli
. Newborns can pick up one of these pathogens during birth or from
their surroundings, particularly if they have weakened immune
systems that would make them more susceptible.
Symptoms of infection in newborns aren't very specific and
may include persistent crying, irritability, sleeping more than
usual, lethargy, refusing to take the breast or bottle, low or
unstable body temperature, jaundice, pallor, breathing problems,
rashes, vomiting, or diarrhea. As the disease progresses,
babies' fontanels, or soft spots, may begin to bulge.
How is it diagnosed and treated?
Meningitis
, particularly bacterial meningitis, is a serious infection in
newborns. If it is suspected, a doctor will do a lumbar puncture
(also known as a spinal tap), inserting a needle into the spine to
withdraw a sample of cerebrospinal fluid.
Treatment of meningitis depends on what caused it. Infants with
bacterial and fungal meningitis receive antibiotics, while viral
meningitis may be treated with antiviral medication. All infants
with meningitis usually spend time in the hospital for monitoring
and intense supportive care.
Sepsis
What is it?
Sepsis
is a serious infection that involves the spread of germs throughout
the body's blood and tissues. It can be caused by viruses,
fungi, parasites, or bacteria. Some of these infectious agents are
acquired during birth, while others are picked up from the
environment. As with meningitis, the symptoms of sepsis are not
specific and vary from child to child. A lower heart rate,
breathing problems, jaundice, trouble feeding, low or unstable body
temperature, lethargy, or extreme fussiness can all be signs of an
infection.
How is it diagnosed and treated?
To diagnose or rule out sepsis, doctors draw blood and sometimes
examine cerebrospinal fluid and other body fluids to look for
bacteria or other pathogens. They typically look for sepsis and
meningitis in the same work-up. Once a positive diagnosis is made,
the child will receive a course of antibiotics during a stay in the
hospital.
Conjunctivitis
What is it?
Some newborns develop an inflammation of the eye's covering
membranes (or conjunctiva), known as
conjunctivitis or pinkeye
, which appears as redness and swelling in the eye, usually
accompanied by a discharge. Both bacterial and viral infections can
cause conjunctivitis in newborns.
How is it diagnosed and treated?
A thorough physical examination and lab tests on a sample of
discharge from the eye will help the doctor determine the cause of
the infection. Antibiotics, eye drops, or ointment may used to
treat conjunctivitis in a newborn. The infection can be very
contagious, so the doctor may also suggest that other children in
the family limit contact with the baby. If a more serious type of
conjunctivitis is suspected, hospitalization may be necessary.
Candidiasis
What is it?
An overgrowth of the common yeast
candida
, found on everyone's body, leads to the fungal infection
candidiasis. In newborns, it usually shows up as
diaper rash
, but babies can also develop
oral thrush
in the mouth and throat. It causes cracks in the corners of the
mouth and white patches on the tongue, palate, lips, and insides of
the cheeks. Newborns who get thrush have often picked up the fungus
from the mother's vagina during delivery or during
breastfeeding.
How is it diagnosed and treated?
Sometimes the doctor will take a swab of one of the patches in
the mouth and examine it for signs of the fungus. In most cases,
this isn't necessary and treatment is started based on the
appearance of the mouth lesions alone. Thrush can be treated with
liquid antifungal medicine.
Congenital Infections
What are they?
Many infections that affect newborns are transmitted from mother
to infant, either during pregnancy or delivery. Because the baby is
born with them, they're known as congenital infections. They
are most often caused by viruses and parasites.
Congenital infections include:
HIV
(which causes AIDS);
rubella (German measles)
;
chickenpox
;
syphilis
;
herpes
;
toxoplasmosis
; and
cytomegalovirus (CMV)
, the most common congenital infection and the leading cause of
congenital hearing loss. Several of these infections, such as GBS
infection and listeriosis, can be acquired either from the mother
or later from the newborn's environment.
It's more likely that babies will be born with an infection
if their mothers become infected for the first time with a
particular germ while pregnant. However, transmission to the baby
doesn't always occur, so many babies born to mothers with these
infections don't have the infection themselves. Other newborns
may not initially show signs of disease, but may later exhibit its
effects.
The risk these infections pose to an infant often depends on
when the mother is exposed to the germ. With many infections, such
as rubella and toxoplasmosis, the risk is greatest in the first
trimester. If the mother becomes infected then, it can cause
serious problems such as heart disease, brain damage, deafness,
visual impairment, or even miscarriage. Infection later in the
pregnancy may lead to less severe effects on the fetus but can
still cause problems with the infant's growth or
development.
Some early signs of a possible congenital infection include: a
large or small head, small body size, seizures, problems with the
eyes, skin rashes, jaundice, enlarged abdominal organs, and a heart
murmur.
How are they diagnosed and treated?
If a congenital infection is suspected, a doctor will run blood
tests and cultures of blood and other fluids from the infant, and
sometimes the mother, to try to make a diagnosis. Treatment often
includes the antiviral or antibiotic medications that are used to
treat the diseases in older patients, as well as intense supportive
care while the baby's in the hospital. Congenital infections
also call for close medical follow-up to watch for any effects of
the disease that may develop as the infant grows.
Complications of Neonatal Infections
Neonatal infections that aren't treated promptly or that
spread can have serious consequences. Because babies' bodies
and organs are undergoing rapid development, any interruption in
that process can lead to complications, including growth,
developmental, neurological, cardiac, respiratory, and sensory
problems. In some severe cases, neonatal infections can even be
fatal.
With their fragile new immune systems, babies aren't well
equipped to deal with infection. Premature or otherwise
immunocompromised babies are at an even greater risk of developing
a critical disease from a bacterium or virus that might cause a
simple illness in an older child. An early diagnosis, swift
treatment, and close monitoring and care give a baby the best
chance of overcoming the infection.
Can Neonatal Infections Be Prevented?
If a pregnant woman is diagnosed with one of these infections,
or if she is considered at risk of infection, preventive measures
can lower the probability that she will pass it to her baby.
Because many infections can be treated with medicine given to the
mother while she's pregnant, maternal testing is extremely
useful.
In many cases, a quick blood or fluid test can determine if a
pregnant woman should receive treatment. For a woman with
listeriosis, a course of antibiotics usually prevents transmission
of the bacterium to the fetus. Women who are HIV positive are
advised to take antiretroviral medication during pregnancy to lower
the risk that their babies will contract HIV infection.
Other neonatal infections are best prevented through steps that
keep expectant mothers from developing the infection in the first
place.
Women can help protect themselves and their unborn babies
by:
- making sure they've been immunized against rubella and
chickenpox infection before trying to become pregnant
- thoroughly
washing and cooking food
, regularly
washing hands
(particularly before and after preparing food, after using the
toilet, and after coming into contact with bodily fluids and
waste), and avoiding all contact with cat and other animal feces
to lower the risk of contracting bacteria and parasites that lead
to infections such as listeriosis and toxoplasmosis
- practicing safe sex to avoid
sexually transmitted diseases (STDs)
that can lead to congenital infections
Some preventive measures are routine parts of pregnancy and
delivery. Many doctors recommend that an expectant mother have a
simple swab test late in pregnancy to check whether she's
carrying GBS. If she is, she will receive intravenous (IV)
antibiotics during delivery to lower the risk of transmitting the
bacteria to her baby. Doctors also routinely put antibiotic drops
or ointment in newborns' eyes to prevent conjunctivitis caused
by gonorrhea bacteria.
Reviewed by:
Michael L. Spear, MD
Date reviewed: April 2009
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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