References

Ahmad MS, Ali N, Mehboob N, Mehmood R, Ahmad M, Wahid A. Temperature on admission among cases of neonatal sepsis and its association with mortality. J Pak Med Assoc.. 2016; 66:(10)1303-1306

Bayston KF, Cohen J. Bacterial endotoxin and current concepts in the diagnosis and treatment of endotoxaemia. J Med Microbiol.. 1990; 31:(2)73-83 https://doi.org/10.1099/00222615-31-2-73

Cailes B, Kortsalioudaki C, Buttery J Epidemiology of UK neonatal infections: the neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed.. 2018; 103:(6)F547-F553 https://doi.org/10.1136/archdischild-2017-313203

Davis J, Fairley D, Christie S, Coyle P, Tubman R, Shields MD. Human parechovirus infection in neonatal intensive care. Pediatr Infect Dis J.. 2015; 34:(2)121-124 https://doi.org/10.1097/INF.0000000000000510

Fenton-Jones M, Cannon A, Paul SP. Recognition and nursing management of sepsis in early infancy. Emerg Nurse.. 2017; 25:(6)23-29 https://doi.org/10.7748/en.2017.e1704

Fernando AMR, Heath PT, Menson EN. Antimicrobial policies in the neonatal units of the United Kingdom and Republic of Ireland. J Antimicrob Chemother.. 2008; 61:(3)743-745 https://doi.org/10.1093/jac/dkm543

Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med.. 2018; 6:(3)223-230 https://doi.org/10.1016/S2213-2600(18)30063-8

Congenital heart disease in children. 2016. https://tinyurl.com/yh3gc9n4 (accessed 26 March 2021)

Gray SL, Mukherjee A, Pettet GK, Paul SP. In-hospital newborn falls: should all neonates undergo neurological imaging?. Br J Hosp Med.. 2018; 79:(6) https://doi.org/10.12968/hmed.2018.79.6.353

Joint Formulary Committee. British national formulary for children (online). Ibuprofen. 2021. https://bnfc.nice.org.uk/drug/ibuprofen.html#indicationsAndDoses (accessed 29 March 2021)

Machado JR, Soave DF, da Silva MV Neonatal sepsis and inflammatory mediators. Mediators Inflamm.. 2014; 2014 https://doi.org/10.1155/2014/269681

National Institute for Health and Care Excellence. Neonatal infection (early onset): antibiotics for prevention and Treatment [CG149]. 2012. https://www.nice.org.uk/guidance/cg149 (accessed: 26 March 2021)

National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis, and early management. NG51. 2016. https://tinyurl.com/yftqx7w7 (accessed 26 March 2021)

Paul SP, Caplan EM, Morgan HA, Turner PC. Barriers to implementing the NICE guidelines for early-onset neonatal infection: cross-sectional survey of neonatal blood culture reporting by laboratories in the UK. J Hosp Infect.. 2018; 98:(4)425-428 https://doi.org/10.1016/j.jhin.2017.12.015

Paul SP, Goodman A, Remorino R, Bolger S. Newborn falls in-hospital: time to address the issue. Pract Midwife.. 2011; 14:(4)29-32

Polin RA Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics.. 2012; 129:(5)1006-1015 https://doi.org/10.1542/peds.2012-0541

Public Health England. Guidance. Newborn and infant physical examination (NIPE) screening: programme overview 2013. https://tinyurl.com/yh5ufkhc (accessed 29 March 2021)

Public Health England. Updated guidelines on post exposure prophylaxis (PEP) for varicella/shingles. 2019. https://tinyurl.com/ub4a2wxa (accessed 29 March 2021)

Roland D. Paediatric early warning scores: Holy Grail and Achilles' heel. Arch Dis Child Educ Pract Ed.. 2012; 97:(6)208-215 https://doi.org/10.1136/archdischild-2011-300976

Satar M, Ozlü F. Neonatal sepsis: a continuing disease burden. Turk J Pediatr.. 2012; 54:(5)449-457

Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev.. 2014; 27:(1)21-47 https://doi.org/10.1128/CMR.00031-13

Stoll BJ, Gordon T, Korones SB Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr.. 1996; 129:(1)63-71 https://doi.org/10.1016/S0022-3476(96)70191-9

Vergnano S, Menson E, Kennea N Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed.. 2011; 96:(1)F9-F14 https://doi.org/10.1136/adc.2009.178798

Wynn JL, Levy O. Role of innate host defenses in susceptibility to early-onset neonatal sepsis. Clin Perinatol.. 2010; 37:(2)307-337 https://doi.org/10.1016/j.clp.2010.04.001

Recognition and management of neonatal sepsis

08 April 2021
16 min read
Volume 30 · Issue 7

Abstract

Neonatal sepsis results from acute bacterial or viral infection occurring in the first 28 days of life. It causes significant morbidity and mortality, although the outcome can be improved by early recognition and prompt treatment by health professionals. This article describes the most common causes of sepsis, and explains why neonates are particularly vulnerable to infection. It highlights the non-specific way in which an infant with a serious infection may present, indicating the crucial features to elicit during history taking and examination, and emphasising the ‘red-flag’ signs and symptoms that should increase suspicion of a serious illness. The authors have adapted National Institute for Health and Care Excellence guidelines to produce an evidence-based approach to the management of an infant with suspected sepsis, and describe the roles of nurses in ensuring effective treatment and best outcomes for these babies.

Neonatal sepsis occurs when there is a serious bacterial or viral infection manifesting in the first 28 days of life (National Institute for Health and Care Excellence (NICE) 2012). A systematic review with meta-analysis by Fleischmann-Struzek et al (2018) involving 23 studies estimated that it carries a mortality rate of 11–19*. The same study estimated that, globally, 3 million neonates are affected each year; the non-specific and varied nature of presentation may result in late diagnosis and delayed treatment. It is important that health professionals are aware of the condition and suspect sepsis at an early stage. This article details the clinical features of neonatal sepsis and includes two illustrative case studies to provide context.

Neonatal infections are divided into early-onset sepsis (EOS) occurring within the first 48 hours of birth, and late-onset sepsis (LOS) occurring between 2 and 28 days after birth (Cailes et al, 2018). The neonatal infection surveillance network (NeonIN) study involving 12 neonatal units in England over a 10-year period recorded a total of 541 bacterial infections in 443 infants; it recorded an infection rate of 8/1000 live births, and 71/1000 in those admitted to the neonatal unit; sepsis was most common among male infants (56*) born prematurely (<37 weeks) and/or had a low birth weight <2500 g (Vergnano et al, 2011).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content