About Sepsis
Sepsis is a serious infection usually caused by bacteria - which
can originate in many body parts, such as the lungs, intestines,
urinary tract, or skin - that make toxins that cause the immune
system to attack the body's own organs and tissues.
Sepsis can be frightening because it can lead to serious
complications that affect the kidneys, lungs, brain, and hearing,
and can even cause death. Sepsis can affect people of any age, but
is more common in:
- infants under 3 months, whose immune systems haven't
developed enough to fight off overwhelming infections
- the elderly
- people with chronic medical conditions
- those whose immune systems are compromised from conditions
such as HIV
If your infant has a rectal temperature of 100.4º Fahrenheit
(38º Celsius), seems lethargic, irritable, uninterested in eating,
or seems to be having difficulty breathing or appears ill, call
your doctor right away.
In an older child, symptoms may include a fever; your child may
also seem lethargic, irritable, confused, have trouble breathing,
have a rash, appear ill, or may complain that his or her heart
feels like it's racing. Call your doctor right away if your
child has these symptoms.
Sepsis occurs when a serious infection causes the body's
normal reaction to infection to go into overdrive. With sepsis,
bacteria and the toxins they create cause changes in a person's
body temperature, heart rate, and blood pressure, and can result in
dysfunction of the body's organs.
Signs and Symptoms
Sepsis in newborns can produce a wide variety of symptoms.
Frequently, these babies "just don't look right" to
their caretakers.
Symptoms of sepsis in newborns and young infants include:
- disinterest or difficulty in feeding, or vomiting
- fever (above 100.4º Fahrenheit [38º Celsius] rectally) or
sometimes low, unstable temperatures
- irritability or increased crankiness
- lethargy (not interacting and listless)
- decreased tone (floppiness)
- changes in heart rate - either faster than normal (early
sepsis) or significantly slower than usual (late sepsis, usually
associated with shock)
- breathing very quickly or difficulty breathing
- periods where the baby seems to stop breathing for more than
10 seconds (apnea)
- change in skin color - becoming pale or blue
- jaundice (when the skin and eyes look yellow)
- rash
- decreased amount of urine
Older children who have sepsis might have a fever, vomiting, a
rash, change in skin color, trouble breathing, feel like their
hearts are racing, or may be lethargic, irritable, or confused. A
child with sepsis may have started with an infection such as
cellulitis
or pneumonia that seems to be spreading and getting worse, not
better.
Causes of Sepsis
Bacteria are almost always the cause of sepsis in newborns and
infants. Bacteria such as
E. coli
,
Listeria monocytogenes
,
Neisseria meningitidis
,
Streptococcus pneumoniae
,
Haemophilus influenzae type b
,
Salmonella
, and
Group B streptococcus (GBS)
are the more common culprits in sepsis in newborns and infants
younger than 3 months.
Premature babies receiving
neonatal intensive care
are particularly susceptible to sepsis because their immune systems
are even more underdeveloped than other babies, and they typically
undergo invasive procedures involving long-term intravenous (IV)
lines, multiple catheters, and breathing through a tube attached to
a ventilator. The incisions an infant gets for catheters or other
tubes can provide a path for bacteria, some of which normally live
on the skin's surface, to get inside the baby's body and
cause an infection.
In some cases of sepsis in newborns, bacteria enter the
baby's body from the mother during pregnancy, labor, or
delivery. Some pregnancy complications that can increase the risk
of sepsis for a newborn include:
- maternal fever during labor
- an infection in the uterus or placenta
- premature rupture of the amniotic sac (before 37 weeks of
gestation)
- rupture of the amniotic sac very early in labor (18 hours or
more before delivery)
Some bacteria (GBS in particular) can be acquired by the newborn
during delivery - 15 to 30% of pregnant women carry the bacterium
for GBS in the vagina or rectum, where it can be passed from mother
to child during delivery.
Diagnosing and Treating Sepsis
Because symptoms of sepsis can be vague in infants, laboratory
tests play a crucial role in confirming or ruling out sepsis:
- Blood tests (including white blood cell counts) and blood
cultures may be taken to determine whether bacteria are present
in the blood. Other blood tests may be done to see how well
certain organs, such as the liver and kidneys, are
functioning.
- Urine is usually collected by inserting a sterile catheter
into the baby's bladder through the urethra for a few seconds
to remove urine; this will be examined under a microscope and
cultured to check for the presence of bacteria.
- A lumbar puncture (spinal tap) may be performed, depending on
the baby's age and overall appearance. A sample of
cerebrospinal fluid will be tested and cultured to determine if
the baby could have meningitis.
- X-rays, especially of the chest (to make sure there isn't
pneumonia), are sometimes taken.
- If the baby has any kind of medical tubes running into the
body (such as IV tubes, catheters, or shunts), the fluids inside
those tubes may be tested for signs of infection.
Sepsis, or even suspected cases of sepsis in infants, will be
treated in the hospital, where doctors can closely watch the child
and administer strong antibiotics intravenously to fight the
infection.
Typically, doctors start infants with sepsis on antibiotics
right away - even before the diagnosis is confirmed. If needed,
they may start them on IV fluids to keep them hydrated, blood
pressure medication to keep their hearts working properly, and
respirators to help them breathe.
Preventing Sepsis
Although there's no way to prevent all types of sepsis, some
cases can be avoided, namely the transmission of GBS bacteria from
mother to child during childbirth. Pregnant women can have a simple
swab test between the 35th and 37th weeks of pregnancy to determine
if they carry the GBS bacteria.
If a woman tests positive for GBS, she can receive intravenous
antibiotics during labor. It is best if these antibiotics are given
at least 4 hours before delivery, so women who are GBS positive may
need to go to the hospital earlier in labor than others.
Women are at higher risk of carrying GBS if they have a fever
during labor, if the amniotic sac ruptures prematurely, or if they
had other children with sepsis or other diseases triggered by GBS,
such as pneumonia or meningitis. A woman who has not been tested
for GBS, but has one of these risk factors, can receive IV
antibiotics during labor to lower the risk of transmission to her
child.
Another way to help prevent some types of sepsis is through
vaccination. Immunizations routinely given to infants today include
vaccinations against certain strains of pneumococcus and
Haemophilus influenzae
type b that can cause sepsis or occult bacteremia, an infection of
the blood.
Hand washing
can go a long way toward preventing infection. Also make sure that
people who come near your baby are not sick and have been fully
vaccinated. For children with indwelling medical devices, such as
catheters or long-term IV lines, make sure to follow the
doctor's directions for cleaning and accessing the site.
When to Call the Doctor
Symptoms of sepsis can be very difficult to identify in newborns
and young infants, so call your doctor immediately or seek
emergency medical care if your baby shows any of these
symptoms:
- vomiting or difficulty or continued disinterest in
feeding
- fever (100.4º Fahrenheit [38º Celsius] and above rectal
temperature) in newborns and young infants
- labored or unusual breathing
- change in skin color (paler than usual or mildly bluish) or a
rash
- listlessness or lethargy
- change in the sound of the baby's cry or excessive
crying
- change in baby's muscle tone - either seeming too stiff
or especially floppy
- a slower or faster heart rate than usual
- bulging or fullness of the "soft spot" on the
baby's head
- decreased amount of urine
- any type of behavior or appearance that concerns you
If your older child has fever, vomiting, a rash, trouble
breathing, change in skin color, feels like his or her heart is
racing, or is lethargic, irritable, or confused, call the doctor or
get emergency medical care immediately.
These signs don't necessarily mean a child has sepsis, but
it's important to let the doctor know about symptoms to make
sure an infection is caught before it becomes more severe.
Reviewed by:
Larissa Hirsch, MD
Date reviewed: July 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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