Sepsis is when the immune system responds to an infection by attacking the body's own organs and tissues. The infection can originate in many body parts, including the lungs, intestines, urinary tract, or skin.
Sepsis causes the body's normal reaction to infection to go into overdrive. Bacteria from the infection and the toxins they create can change a person's body temperature, heart rate, and blood pressure, and prevent the body's organs from working properly.
Sepsis may lead to serious complications that affect the kidneys, lungs, brain, and heart, 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 or cancer
If your infant is less than 3 months old, has a rectal temperature of 100.4ºF (38ºC), seems lethargic, irritable, uninterested in eating, having difficulty breathing or appears ill, take your baby to see a doctor immediately.
In older babies and children, symptoms may include a fever, irritability, difficulty breathing, and lethargy. A child may also seem 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.
Signs and Symptoms
Sepsis in newborns can produce a variety of symptoms. Frequently, these babies "just don't look right" to their caretakers.
Symptoms of sepsis in newborns and young babies include:
- disinterest or difficulty feeding, or vomiting
- fever (above 100.4ºF [38ºC] or higher rectally) or sometimes low 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, patchy, and/or blue
- jaundice (when the skin and eyes look yellow)
- decreased amount of urine (pee)
- bulging or fullness of the soft spot on the baby’s head
Older infants and children who have sepsis might have fever, vomiting, rash, change in skin color, trouble breathing, feel like their heart is racing, or feel 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/or getting worse, not better.
Causes of Sepsis
Bacteria are almost always the cause of sepsis in newborns and infants. Bacteria such as group B streptococcus (GBS), Escherichia coli, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, and Salmonella are common culprits in sepsis in newborns and infants younger than 3 months old.
Premature babies receiving neonatal intensive care are particularly at risk for sepsis because their immune systems are more underdeveloped than other babies'. And they usually undergo invasive procedures involving long-term intravenous (IV) lines, various catheters or tubes, and breathing through a tube attached to a ventilator. The incisions an infant gets during the placement of 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) are done to see whether bacteria are in the blood. Other blood tests may be done to see how well certain organs, such as the liver and kidneys, are functioning.
- A urine test is usually done by temporarily inserting a sterile catheter into the baby's bladder through the urethra to collect a small sample of pee; this will be examined under a microscope and cultured to check for bacteria.
- A lumbar puncture (also called a spinal tap) may be done, depending on the baby's age and overall appearance. A sample of spinal fluid will be tested and cultured to see if the baby could have meningitis, an infection of the membranes covering the brain and spinal cord.
- X-rays, especially of the chest (to check for 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 might be tested for signs of infection.
Sepsis, or even suspected cases of sepsis, will be treated in the hospital, where doctors can closely watch the child and administer antibiotics intravenously (through an IV) to fight the infection.
Usually, doctors start infants with sepsis on antibiotics right away — even before the diagnosis is confirmed. If needed, babies might receive IV fluids to keep them hydrated, blood pressure medication to keep their hearts working properly, and respirators to help them breathe.
There's no way to prevent all types of sepsis. But some cases can be avoided by preventing 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 (IV) antibiotics during labor. It is best if these antibiotics are given at least 4 hours before delivery, so women in labor who are GBS positive should go to the hospital early.
Women are at greater 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, may receive IV antibiotics during labor to lower the risk of transmission to her newborn.
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.
Regular hand washing is the best way to prevent infection. Also, make sure people who are sick don't get close to your baby. Children and adults handling young infants should be up-to-date with vaccinations.
For children with medical devices like catheters or long-term IV lines, make sure to follow the doctor's directions for cleaning and accessing the device.
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:
- disinterest in feeding
- fever (100.4ºF [38ºC] 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 the 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 infant or 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: Adalberto Torres Jr., MD
Date reviewed: April 2014