Author: Mitali Parmar, MD (EM Resident Physician, PGY-3, NUEM) // Edited by: Michael Macias, MD (EM Resident Physician, PGY-4, NUEM) // Expert Commentary: Emily Roben, MD
Citation: [Peer-Reviewed, Web Publication] Parmar M, Macias M (2016, August 23). Neonatal Sepsis: A Visual Guide [NUEM Blog. Expert Commentary By Roben E]. Retrieved from http://www.nuemblog.com/blog/neonatal-sepsis/
This infographic provides a very succinct and complete view of the salient points related to the diagnosis and treatment of neonatal sepsis. Some items to keep in mind are:
- The risk factors listed here are the most common items that we ask about when taking a history on a neonate with concern for sepsis. However, many times this historical information is not available or none of these risk factors are present. Just remember that any neonate under 28 days old, no matter the birth history or maternal history, is considered at risk for sepsis if they present to the ED with complaints of fever, poor feeding, lethargy, or other systemic symptoms.
- Presentations for neonatal sepsis can be vague, varied, and odd. Abnormal vital signs are often not part of the presentation. It can vary from something as subtle as "she just doesn't seem right" to something as ominous as focal seizures.
- Under 28 days of age, babies who are being worked up for sepsis need a "full" sepsis workup; this includes CBC, blood culture, UA, urine culture, and CSF studies. Typical CSF studies are gram stain, culture, protein, glucose, and cell count. You can also add CSF HSV testing if the mother has this history or if the baby looks particularly ill. Consider sending a C-reactive protein from the serum, as this is sometimes used to prognosticate in cases of probable but unproven sepsis.
- Treatment is with IV Ampicillin and Gentamicin or Ampicillin and Cefotaxime. These combinations cover for Group B strep, E.coli, and other common gram negative pathogens. (Ceftriaxone is generally NOT used in babies under 6-8 weeks, because it is thought to interfere with protein binding with bilirubin, potentially causing iatrogenic hyperbilirubinemia). If you suspect HSV infection (i.e. if you're sent an HSV PCR) then you should also add IV Acyclovir to the treatment regimen.
Emily C.Z. Roben, MD
Pediatric Emergency Medicine Fellow; Lurie Children's Hospital