Pediatric Sepsis or Septic Shock

Sepsis can develop following infection by microorganisms including bacteria, viruses, fungi and parasites. Infection in babies can be contracted during pregnancy, from the mother's genital tract during labor and delivery or after birth from contact with others.

Sepsis in a newborn is more likely to develop when the mother has had pregnancy complications that increase the likelihood of infection. Such complications may include the following:

• Premature rupture of the membranes (amniotic sac), or membrane rupture for an extended length of time
• Bleeding problems
• A difficult delivery
• Infection in the uterus or placental tissues
• Fever in the mother

Babies can also develop sepsis by contracting infections after birth from infected persons or objects. Babies in the neonatal intensive care unit (NICU) are at increased risk for acquiring nosocomial (hospital-acquired) infections. Many babies in the NICU are premature or have low birthweight which makes them more susceptible to infection and more likely to need invasive treatments and procedures. Microorganisms that normally live on the skin may cause infection if they enter the body through catheters and other tubes inserted into the baby's body.

Prenatal

• Listeria monocytogenes

During Delivery

• Group B streptococcus (GBS)
• E. coli
• Herpes simplex virus

After Birth

• Respiratory syncytial virus (RSV)
• Candida
• Haemophilus influenzae type b (Hib)
• Enterovirus

Sepsis can be life-threatening for newborns, especially if the baby has a weakened immune system because of prematurity or another illness. When a baby's immature immune system cannot fight the microorganism, the infection can quickly spread and overtake the body, causing serious illnesses such as meningitis or pneumonia.

Sepsis in newborns is not always easy to identify since newborn babies often do not show symptoms of infections in the same way older babies and children may show symptoms. The following are some of the symptoms of infection in newborn babies. However, each baby may experience symptoms differently depending on the type of organism causing the infection and the severity and location of the infection. Symptoms of infection may include the following:

• Apnea (stopping breathing) or difficulty breathing
• Bradycardia (decreased heart rate)
• Decreased temperature or temperature instability
• Weak suck
• Pale or mottled coloring or jaundice (yellow coloring of the skin and eyes)

A sepsis workup may be needed to help identify the location of the infection and type of microorganism causing the infection. A sepsis workup may include the following procedures:

• Blood tests
• Lumbar puncture (also called spinal tap). This is a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord.
• Blood cultures
• Urine culture. This may be obtained with a catheter or sometimes by suprapubic tap, insertion of a needle through the lower abdomen into the bladder. 
• Culture of fluids from inside tubes and catheters that are inserted in the baby.
• X-rays. This is a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.

Procedures may also be done to determine which antibiotics or medications are most effective for treating the specific microorganism.

Specific treatment for sepsis will be determined by your baby's doctor based on:

• Your baby's age, overall health and medical history
• Extent of the disease
• Your baby's tolerance for specific medications, procedures or therapies
• Expectations for the course of the disease
• Your opinion or preference

Early diagnosis and treatment of the infection are important in helping prevent sepsis from overwhelming a baby's body. However, cultures of blood and body fluids may take several days for the organism to grow and be identified. Because of this, babies who are at increased risk for sepsis, such as premature or low birthweight babies, may have preventive antibiotic treatment started as soon as cultures are taken. Most medications are given intravenously (IV).

Sepsis can be life threatening as the infection can affect several body systems at the same time. This can make providing treatment more difficult. Babies with sepsis will require care in the newborn intensive care unit (NICU), and may need antibiotics, other medications, and specialized treatment (such as a mechanical breathing machine). The healthcare team will be working to provide the best treatment for the infection and care for your baby.