Infant Sepsis

What is Sepsis?

Sepsis is a rare but severe bacterial infection that is present in the blood and spreads throughout the body. In newborns, it is also called Sepsis Neonatorum or Neonatal Septicemia. The bacteria creates a toxin that causes widespread inflammation of the body’s organs.

Sepsis is frightening because it can lead to serious complications that affect the kidneys, lungs, brain, hearing, and vision. Sepsis can affect anyone but it is more common in infants up to 3 months, usually because their immune systems haven't developed enough to fight off overwhelming infections.

Sepsis Neonatorum or Neonatal Septicemia can be life threatening for newborns, especially if the baby has a weakened immune system because of prematurity or another illness. The mortality rate with sepsis may be as high as 50% for newborns who are not treated. ^[1]

What Causes Infant Sepsis?

Sepsis occurs most frequently immediately after birth. B streptococcus (strep) is the most common cause of infection among infants. Infections in babies can be contracted during pregnancy, from the mother's genital tract during labor and delivery, or after birth from contact with others.

Pregnant women may carry the bacteria without any symptoms and unknowingly pass it on to their baby during pregnancy, labor or delivery. At least one out of every five pregnant women carries the bacterium for Group B streptococcus, where it can be passed from mother to child during delivery.^[2]  

Premature babies receiving neonatal intensive care are more susceptible to sepsis because their immune systems have not yet developed enough to fight off infections. Babies in the newborn intensive care unit are at an increased risk for acquiring sepsis.

Preemies typically undergo invasive procedures involving intravenous (IV) lines, multiple catheters, and need to breathe through a tube attached to a ventilator. Incisions for catheters or other tubes can provide a path for bacteria, which normally live on the skin's surface, to get inside the baby's body and cause the infection.

Premature babies also lack certain antibodies against specific bacteria; these antibodies usually cross the placenta from the mother late in pregnancy. 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:

• 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)
• A long and difficult delivery
• Infection in the uterus or placenta
• Maternal fever during labor
• Bleeding

What Are the Symptoms of a Sepsis Infection?

Sepsis in newborns produces symptoms that can vary widely.  Some of the more common signs or symptoms of sepsis in newborns and young infants include: change in skin color (paler than usual or mildly bluish), irritability, lethargy, decreased tone (floppiness), disinterest or difficulty in feeding, fever, changes in heart rate (either faster than normal (early sepsis) or significantly slower than usual (late sepsis, usually associated with shock), decreased amount of urine, an unusual rash, breathing very quickly or difficulty breathing, apnea (stopping breathing) or difficulty breathing and/or jaundice. 

Laboratory tests play an important role in confirming sepsis because symptoms of sepsis can be vague in infants. Blood tests and blood cultures can determine whether bacteria causing sepsis are present in the blood.  A baby’s urine can be collected and examined under a microscope and cultured to check for the presence of bacteria-causing sepsis. A lumbar puncture (spinal tap) may be performed in some circumstances and chest x-rays may determine if pneumonia is present.

A CT scan can determine whether or not an infection exists in the abdomen. If the baby has medical tubes running into his or her body (such as tubes, catheters, or shunts), the fluids inside those tubes can be tested for signs of sepsis.

How is Sepsis Treated?

Early diagnosis and treatment of the infection are important in helping prevent sepsis from overwhelming a baby's body. Even suspected cases of sepsis in infants can be treated in the hospital where doctors can closely watch the infection. Strong antibiotics can be given intravenously to fight the infection.  If more symptoms of sepsis begin to appear, they usually start them on IV fluids to keep them hydrated, blood pressure medication to keep their hearts working properly, and respirators to help them breathe.

How Can Sepsis Be Prevented?

Although there's no way to prevent all types of sepsis, some cases can be avoided, in particular the transmission of Group B streptococcus (“GBS”) bacteria from mother to child during childbirth. There is a simple swab test for pregnant women during the 35th and 37th weeks of pregnancy and again just before the birth to determine if they carry the GBS bacteria.  Antibiotics can be given during labor to mothers who are found to carry the bacteria so as to prevent passing it on to their babies.

Women are at higher risk of carrying GBS if they have a fever during labor, if the amniotic sac ruptures prematurely, if they have prolonged labor, or if they had other children with sepsis or other diseases triggered by GBS, such as pneumonia or meningitis. A woman with one of these risk factors can receive intravenous antibiotics to lower her risk of transmitting the bacteria to her baby.

Medical Mistakes Can Result in Sepsis or Other Infections.

Precautions can be taken by the medical staff after the birth to keep the newborn from developing a sepsis infection. Medical personnel are responsible for taking precautions during the delivery and keeping infants in a sterile environment while they are in the hospital.

Delayed diagnosis and treatment of sepsis could lead to permanent neurological injuries such as cerebral palsy, epilepsy, and mental disabilities.  Failure to identify sepsis and subsequent inappropriate treatment as well as failure to transfer an infant with sepsis to a neonatal intensive care unit in a timely manner are also examples of potential medical mistakes.
 
If a doctor or other health care professional fails to monitor or to respond properly to certain situations that arise during the delivery, that individual could be considered negligent with regard to the duty owed to patients. A delivery medical team should monitor the mother and baby throughout pregnancy, labor and delivery in order to be aware of any complications that may develop. Negligence of doctors, nurses, (See "Nursing Negligence"). Examples of such negligence include:

• Failure to provide appropriate prenatal care and appropriate interventions during labor and delivery
• Failure to diagnose and treat an infection in the mother
• Failing to rapidly diagnose and treat preterm labor
• Failure to diagnose macrosomic (large) baby
• Failure to properly manage prolonged or post term pregnancy
• Failing to respond appropriately to bleeding
• Failure to treat maternal elevated blood pressure (preeclampsia)
• Negligent management of labor and delivery
• Failure to appropriately respond and intervene to non-reassuring fetal heart monitor changes and evidence of fetal distress.
• Misuse of a vacuum extractor or forceps during delivery
• Failure to perform a timely vaginal delivery or a cesarean section (c-section) to deliver a baby in distress
• Failure to properly resuscitate a newborn

If the medical staff fails to provide adequate prenatal and postnatal care, they may be held liable for your child’s injuries. Only a careful review of the medical records can determine the cause of injuries and whether the actions of the delivery team played a part in causing the sepsis. Our lawyers and medical analysts who handle birth injury cases have experience investigating medical mistakes and birth injury malpractice and have the resources to access the type of qualified medical experts necessary to review complicated birth injury cases.

Contact Us for a Free Case Evaluation

If you or your child suffered a birth injury from sepsis due to improper care during your pregnancy or at the time of delivery, perhaps we can help. You will be able to speak to a registered nurse who understands the complex issues of labor and delivery that can result in serious injury.

Call 1.800.552.7115 or complete our free case evaluation form to speak to a medical analyst who understands. There is no charge for this call or evaluation.

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