pediatrics
Neonatal Sepsis
Symptoms and Signs of Neonatal Sepsis
Early signsof neonatal sepsis are frequently nonspecific and subtle and do not distinguish among organisms (including viral). Particularly common early signs include Diminished spontaneous activity Less vigorous sucking Anorexia Apnea Bradycardia Temperature instability (hypothermia or hyperthermia) Fever is present in only 10 to 15% of neonates but, when sustained (eg,>1 hour), generally indicates infection. Other symptoms and signs include respiratory distress, neurologic findings (eg, seizures, jitteriness), jaundice (especially occurring within the first 24 hours of life without Rh or ABO blood group incompatibility and with a higher than expected direct bilirubin concentration), vomiting, diarrhea, and abdominal distention. Specific signs of an infected organ may pinpoint the primary site or a metastatic site. Most neonates with early-onset group B streptococcus (and many withL. monocytogenes) infection present with respiratory distress that is difficult to distinguish from respiratory distress syndrome. Periumbilical erythema, discharge, or bleeding without a hemorrhagic diathesis suggests omphalitis (infection prevents obliteration of the umbilical vessels). Coma, seizures, opisthotonos, or a bulging fontanelle suggests meningitis, encephalitis, or brain abscess. Decreased spontaneous movement of an extremity and swelling, warmth, erythema, or tenderness over a joint indicates osteomyelitis or pyogenic arthritis. Unexplained abdominal distention may indicate peritonitis or necrotizing enterocolitis (particularly when accompanied by bloody diarrhea and fecal leukocytes). Cutaneous vesicles, mouth ulcers, and hepatosplenomegaly (particularly with disseminated intravascular coagulation [DIC]) can indicate disseminated herpes simplex. Early-onset group B streptococcus (GBS) infection may manifest as a fulminating pneumonia. Often, obstetric complications (particularly prematurity, PROM, or chorioamnionitis) have occurred. In>50% of neonates, GBS infection manifests within 6 hours of birth; 45% have an Apgar score of<5. Meningitis may also be present but is not common. In late-onset GBS infection (at > 3 days to 12 weeks), meningitis is often present. Late-onset GBS infection is generally not associated with perinatal risk factors or demonstrable maternal cervical colonization and may be acquired postpartum. 