- General Description
- The Symptoms and Clinical Picture
- Diagnosis of Bacterial Sepsis of the Newborn
- Treatment of Bacterial Sepsis of Newborn
Bacterial sepsis of newborn (neonatal sepsis) is a generalized infectious disease, manifested with suppurative focus, bacteremia, systemic inflammatory response and multiple organ failures.
Neonatal sepsis is provoked by potentially pathogenic bacterial microflora. The most common cause of infection during fetal development and intranatal period is S. Agalacticae representative of the streptococcal group A. Less often, sepsis is provoked by E. Coli and other intestinal gram-negative flora.
The disease develops when there is suppurative focus, from which, provided low immune body protection, the pathogen penetrates into the bloodstream, causing bacteremia, toxinemia and antigenic stimulation with products of life and decay. Organism responds to infection with systemic inflammatory reaction, manifested with the release of pro-inflammatory cytokines and activation of the neutrophils, complement system, coagulation and platelet aggregation. Excessive system response, along with toxic and antigen impact of the pathogen, results in damaging action on the organs and systems of the body. It is followed by disturbed microcirculation, permeability and endothelial function of capillaries, intravascular coagulation syndrome develops. Further multiple organ dysfunctions occur.
The Symptoms and Clinical Picture
There is early neonatal sepsis when clinic appears in the first 3 days after birth, and late neonatal sepsis, which occurs after 4 days of the life of a newborn. Typical initial manifestations of sepsis are a severe condition of the child, fever or hypothermia in prematurely born, degeneration of the Central Nervous System in the form of oppression or anxiety. Integuments are dirty-pale color, with expressed marbling, facial features are pointy, hemorrhage and acrocyanosis are often present.
In the future, respiratory and cardiac insufficiency, as well as cholestatic jaundice may develop, which is a manifestation of multiple organ failures. In 10-15 % of cases of septic shock develops, characterized by rapid deterioration, hypothermia, tachycardia, arterial hypotension, bleeding, and DIC-syndrome.
Diagnosis of Bacterial Sepsis of the Newborn
The diagnosis is established on the basis of characteristic clinical manifestations of sepsis and laboratory markers of acute inflammation: changes in the overall analysis of the blood, increased C-reactive protein, increased levels of procalcitonin and interleukin-8, as well as other proinflammatory cytokines. Differential diagnosis is performed with generalized forms of viral infections, mycosis and congenital metabolic diseases (galactosemia, congenital defects of amino acid exchanges).
Treatment of Bacterial Sepsis of Newborn
A complex of medical activities should be carried out, including hygiene measures, proper feeding of a newborn, etiotropic therapy and pathogenetic treatment aimed at rehabilitation of hemostasis and improvement of immune protection. Fighting with infection has a leading value. To this end, antibiotics or combination of antibiotics with bactericidal action, able to penetrate the blood-brain barrier, are used.
Correction of humoral immunity is carried out with immune supportive therapy based on immunoglobulins (Penta globin). If there is a violation of cellular immunity, recombinant interleukin is prescribed. Infusion therapy is applied, allowing to fill the volume of circulating blood and restore the balance of electrolytes.