Pediatric emergency medicine trisk 2578 2578

Neonatal sepsis should always be considered in any sick newborn
presenting with symptoms of respiratory distress, hypotension,
electrolyte disturbance, poor feeding, or lethargy.
Neonatal sepsis often presents with hypothermia. Neonates may not
react to an infection with fever.
Avoid ceftriaxone due to its ability to displace bilirubin and aggravate
hyperbilirubinemia.
Neonates with a suspected UTI should have a full sepsis workup and
be admitted for intravenous antibiotic therapy.
Direct hyperbilirubinemia or new onset of jaundice after 8 days of life is
suspicious for a neonatal UTI.
Current Evidence
Concern for neonatal sepsis is one of the most commonly encountered clinical
situations for newborns in the ED. General incidence of sepsis in neonates is
approximately 0.98 per 1,000 live births. It can be categorized into early onset
(occurring in newborns who are less than 72 hours of life) or late onset (occurring
between 3 and 7 days of life).
Early-onset disease occurs through perinatal or vertical transmission from the
mother. Early-onset disease is caused by microbial flora present in the vaginal
tract (GBS, E. coli or other gram-negative bacilli, Staphylococcus aureus,
Enterococci, viridans group Streptococci, Group A Streptococci, syphilis, H.
influenzae , Listeria monocytogenes ). Risk factors for early-onset disease usually
relate to perinatal exposures (prolonged rupture of membranes, chorioamnionitis,
GBS-colonized mother with inadequate intrapartum antibiotics).
Late-onset disease may occur through horizontal transmission from the infant’s
environment or caregivers and is caused by environmental flora (Staphylococci,
E. coli, GBS, and candidiasis). Although more commonly seen in the NICU, risk
factors for late-onset disease include prematurity, presence of congenital heart
disease, gut pathology, and presence of central catheters.
Other pathogens causing sepsis include viral (herpes simplex, enterovirus,
cytomegalovirus, adenoviruses), fungal (systemic candidiasis), and atypical

bacteria (Toxoplasma) agents. Neonatal infection induces a systemic
inflammatory response which accounts for much of the capillary leak and
inflammation associated with the disease.